Renal Pathology Practice Questions

Q: Presence of which of the following correlates best with renal pathology?

Broad cast. **Explanation:** The presence of **Broad casts** is the most significant indicator of severe, chronic renal pathology. These casts are formed in the **collecting ducts** that have undergone compensatory dilatation due to the destruction of surrounding nephrons. Because they are molded in these wide, damaged tubules, they are significantly wider than ordinary casts. Their presence typically signifies **End-Stage Renal Disease (ESRD)** or advanced Chronic Kidney Disease (CKD), earning them the name "Renal Failure Casts." **Analysis of Other Options:** * **Hyaline Casts:** These are composed of Tamm-Horsfall protein [1]. They are the most common type of cast and are often **non-pathological**, seen in healthy individuals following strenuous exercise, dehydration, or concentrated urine. * **Coarse Granular Casts:** These represent the degeneration of cellular casts (like tubular epithelial cells) [1]. While they indicate stasis and some degree of renal disease (like ATN), they are less specific for permanent, end-stage structural damage than broad casts. * **Epithelial Casts:** These consist of sloughed renal tubular epithelial cells. They are highly characteristic of **Acute Tubular Necrosis (ATN)**, ethylene glycol poisoning, or heavy metal ingestion, representing acute injury rather than chronic pathology. **High-Yield Clinical Pearls for NEET-PG:** * **Broad Waxy Casts:** Pathognomonic for chronic renal failure/ESRD. * **RBC Casts:** Hallmark of **Glomerulonephritis** (e.g., Nephritic syndrome) [1]. * **WBC Casts:** Characteristic of **Acute Pyelonephritis** or Tubulointerstitial nephritis. * **Fatty Casts ("Maltese Cross"):** Seen in **Nephrotic Syndrome** (Lipiduria). * **Muddy Brown Casts:** Classic finding in **Acute Tubular Necrosis (ATN)**. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 520-521.

Q: The gene for Wilms tumor is located on which chromosome?

Chromosome 11. **Explanation:** The correct answer is **Chromosome 11**. Wilms tumor (Nephroblastoma) is the most common primary renal tumor of childhood. Its pathogenesis is deeply rooted in the loss of tumor suppressor genes located on chromosome 11 [1]. Specifically, the **WT1 gene** is located at **11p13**, and the **WT2 gene** is located at **11p15** [1]. Mutations or deletions in these regions disrupt normal nephrogenesis, leading to the persistence of embryonal blastema and subsequent tumor formation. **Analysis of Options:** * **Chromosome 11 (Correct):** Houses the WT1 gene (associated with WAGR syndrome and Denys-Drash syndrome) and the WT2 gene (associated with Beckwith-Wiedemann syndrome) [1]. * **Chromosome 1:** While abnormalities in 1q are sometimes seen as secondary changes in Wilms tumor progression, it is not the primary locus for the Wilms tumor gene. * **Chromosome 10:** Associated with the **PTEN gene** (Cowden syndrome) and **RET proto-oncogene** (MEN 2A/2B), but not Wilms tumor. * **Chromosome 12:** Associated with certain lipomas and sarcomas (MDM2 amplification), but not classically linked to Wilms tumor. **High-Yield Clinical Pearls for NEET-PG:** * **WAGR Syndrome:** Wilms tumor, Aniridia, Genitourinary anomalies, and mental Retardation (Deletion at 11p13) [1]. * **Denys-Drash Syndrome:** Wilms tumor, intersex disorders, and early-onset nephropathy (WT1 mutation). * **Beckwith-Wiedemann Syndrome:** Wilms tumor, macroglossia, organomegaly, and hemihypertrophy (WT2 mutation/imprinting defect at 11p15.5). * **Triphasic Histology:** Classic Wilms tumor shows three components: **Blastema** (sheets of small blue cells), **Stroma** (fibrocytic or myxoid), and **Epithelium** (abortive tubules/glomeruli). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 487-488.

Q: In thin basement membrane disease, the defect is in which component?

a3 and a4 chains of type IV collagen. **Explanation:** **Thin Basement Membrane Disease (TBMD)**, also known as benign familial hematuria, is a hereditary glomerular disease characterized by diffuse thinning of the glomerular basement membrane (GBM) [1]. **Why Option B is correct:** The GBM is primarily composed of **Type IV collagen**. In TBMD, the molecular defect lies in the genes **COL4A3 and COL4A4**, which encode the **̑3 and ̑4 chains of type IV collagen**, respectively. Most cases are inherited in an autosomal dominant pattern. This defect leads to a reduction in the thickness of the GBM (typically 150–250 nm, compared to the normal 300䀀 nm), resulting in persistent microscopic hematuria [1]. **Why other options are incorrect:** * **Options A:** The ̑1 and ̑2 chains of type IV collagen are found in all basement membranes, but mutations in these are not the primary cause of TBMD. * **Options C & D:** Type VI collagen is not the structural backbone of the glomerular basement membrane; Type IV is the "network-forming" collagen essential for the filtration barrier. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Most common cause of asymptomatic microscopic hematuria [1]. It has an excellent prognosis (unlike Alport Syndrome). * **Electron Microscopy (Gold Standard):** Shows diffuse thinning of the GBM. * **Alport Syndrome Connection:** While TBMD involves ̑3/̑4 mutations (often heterozygous), Alport syndrome typically involves the **̑5 chain** (X-linked) and presents with deafness and ocular defects [1]. * **Immunofluorescence:** Usually negative (no immune deposits). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 929-930.

Question 1

Which of the following conditions does NOT cause crescentic glomerulonephritis?

Accepted Answer

Alport syndrome

Answer

Rapidly progressive glomerulonephritis

Answer

Goodpasture syndrome

Answer

Henoch-Schönlein purpura

Question 2

Presence of which of the following correlates best with renal pathology?

Accepted Answer

Broad cast

Answer

Hyaline cast

Answer

Coarse granular cast

Answer

Epithelial cast

Question 3

Hepatic fibrosis is associated with which of the following conditions?

Accepted Answer

Autosomal recessive polycystic kidney disease (ARPKD)

Answer

Medullary cystic kidney disease

Answer

Autosomal dominant polycystic kidney disease (ADPKD)

Answer

Nephronophthisis

Question 4

The gene for Wilms tumor is located on which chromosome?

Accepted Answer

Chromosome 11

Answer

Chromosome 1

Answer

Chromosome 10

Answer

Chromosome 12

Question 5

Which one of the following is not a feature of clear cell carcinoma of the kidney?

Accepted Answer

Childhood tumour

Answer

Bony secondaries

Answer

Haematuria

Answer

Renal vein invasion

Question 6

An IV drug abuser develops an aggressive form of nephrotic syndrome that does not respond to steroids. A renal biopsy is performed. Which of the following histological diagnoses will most likely be made from the biopsy tissue?

Accepted Answer

Focal segmental glomerulosclerosis

Answer

IgA nephropathy

Answer

Membranous glomerulonephritis

Answer

Membranoproliferative glomerulonephritis

Question 7

A 14-year-old girl presents with a 5-day history of hypertension, oliguria, and hematuria. She was seen 2 weeks earlier for a severe throat infection with group A beta-hemolytic streptococci. A kidney biopsy displays glomerulonephritis. Immunofluorescence staining for which of the following proteins would provide the strongest evidence that this patient's glomerulonephritis is mediated by immune complexes?

Accepted Answer

Complement

Answer

Fibrinogen

Answer

Hageman factor (clotting factor XII)

Answer

Plasminogen

Question 8

In thin basement membrane disease, the defect is in which component?

Accepted Answer

a3 and a4 chains of type IV collagen

Answer

a1 and a2 chains of type IV collagen

Answer

a1 and a2 chains of type VI collagen

Answer

a3 and a4 chains of type VI collagen

Question 9

Familial Renal Cell Carcinoma is associated with which of the following genetic syndromes?

Accepted Answer

Von Hippel-Lindau syndrome

Answer

Turner syndrome

Answer

Alport syndrome

Answer

Peutz-Jeghers syndrome

Question 10

What is the most common renal pathology observed in patients experiencing shock?

Accepted Answer

Acute tubular necrosis

Answer

Acute cortical necrosis

Answer

Renal vein thrombosis

Answer

Acute medullar necrosis

Renal Pathology — MCQs

Renal Pathology — MCQs

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