Renal Pathology Practice Questions

Q: Hereditary nephritis is seen in which of the following conditions?

Alport syndrome. **Explanation:** **Alport Syndrome (Correct Answer):** Alport syndrome is a classic example of **hereditary nephritis**. It is primarily an X-linked dominant disorder (85% of cases) caused by mutations in the **COL4A5 gene**, which encodes the α-5 chain of **Type IV collagen**. This collagen is a crucial structural component of the glomerular basement membrane (GBM), cochlea, and lens. Defective collagen leads to thinning and splitting of the GBM, clinically manifesting as the triad of **hereditary hematuria, sensorineural deafness, and ocular defects** (e.g., anterior lenticonus) [1]. **Analysis of Incorrect Options:** * **Analgesic Nephropathy:** An **acquired** chronic tubulointerstitial nephritis caused by the cumulative ingestion of large quantities of NSAIDs or phenacetin. It is characterized by renal papillary necrosis. * **Balkan Nephropathy:** An **acquired** environmental form of interstitial nephritis found in the Danube River basin. It is linked to the ingestion of **aristolochic acid** (from the plant *Aristolochia clematitis*) and carries a high risk of transitional cell carcinoma. * **Eosinophilic Nephritis:** Typically an **acquired** hypersensitivity reaction (Acute Interstitial Nephritis) often triggered by drugs like NSAIDs, antibiotics (penicillins), or diuretics. **High-Yield Clinical Pearls for NEET-PG:** * **Electron Microscopy (EM):** The hallmark of Alport syndrome is a **"Basket-weave appearance"** due to irregular thickening, thinning, and splitting of the lamina densa. * **Immunofluorescence:** Shows a characteristic **negative staining** for Type IV collagen chains [1]. * **Goodpasture Syndrome vs. Alport:** While both involve Type IV collagen, Goodpasture is an autoimmune attack against the α-3 chain, whereas Alport is a genetic deficiency. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 929-930.

Q: The most characteristic finding in diabetic nephropathy is:

Nodular glomerulosclerosis. **Explanation:** **Nodular glomerulosclerosis**, also known as **Kimmelstiel-Wilson (KW) lesions**, is considered the most characteristic (pathognomonic) histological finding in diabetic nephropathy [1]. These are ovoid, laminated, hyaline eosinophilic masses located in the periphery of the glomerulus, resulting from increased mesangial matrix production and basement membrane thickening. **Analysis of Options:** * **A. Diffuse glomerulosclerosis:** This is actually the **most common** lesion in diabetic nephropathy [1]. It involves a generalized increase in mesangial matrix. While frequent, it is not as specific (characteristic) as the nodular form. * **C. Armanni-Ebstein reaction:** This refers to vacuolation and glycogen deposits in the epithelial cells of the **proximal convoluted tubules** (pars recta). While seen in diabetes, it is a tubular change, not a glomerular one, and is less common today due to better glycemic control. * **D. Fibrin caps:** These are hyaline accumulations on the surface of glomerular capillaries. Along with **Capsular drops**, they are features of diabetic nephropathy but are non-specific as they can occur in other glomerular diseases. **High-Yield Clinical Pearls for NEET-PG:** * **Earliest Clinical Sign:** Microalbuminuria (30-300 mg/day). * **Earliest Morphological Change:** Thickening of the Glomerular Basement Membrane (GBM) [2]. * **Pathogenesis:** Non-enzymatic glycosylation of proteins leading to Advanced Glycation End-products (AGEs). * **Vascular Change:** Hyaline arteriolosclerosis affecting **both** afferent and efferent arterioles (highly suggestive of diabetes). * **Kimmelstiel-Wilson nodules** are PAS-positive [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1121-1122. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, p. 1121.

Q: Malakoplakia of the bladder is associated with which of the following?

Defect in phagocytosis. **Explanation:** **Malakoplakia** is a rare, chronic inflammatory condition most commonly affecting the urinary bladder. It is characterized by a **defect in phagocytosis**, specifically an acquired impairment in the bactericidal activity of macrophages. 1. **Why the correct answer is right:** In Malakoplakia, macrophages (known as **von Hansemann cells**) can ingest bacteria (most commonly *E. coli*) but are unable to digest them completely due to defective lysosomal function. This leads to the accumulation of partially digested bacterial components and calcium/iron salts within the cytoplasm. These calcified concentric inclusions are called **Michaelis-Gutmann bodies**, which are the pathognomonic histological hallmark of the disease. 2. **Why the incorrect options are wrong:** * **Smoking & Aniline dye:** These are major risk factors for **Urothelial (Transitional Cell) Carcinoma** of the bladder, not inflammatory conditions like Malakoplakia [1]. * **Contrast dye:** While contrast media can cause nephrotoxicity (Acute Tubular Necrosis), it has no association with the pathogenesis of Malakoplakia. **High-Yield Facts for NEET-PG:** * **Pathognomonic Feature:** Michaelis-Gutmann bodies (calcified siderotic granules). * **Stains:** These bodies are positive for **PAS**, **Von Kossa** (calcium), and **Prussian Blue** (iron). * **Common Organism:** *Escherichia coli* is implicated in 90% of cases. * **Clinical Presentation:** Often presents as soft, yellowish, slightly raised mucosal plaques on the bladder wall, mimicking a tumor. * **Patient Profile:** Often seen in immunosuppressed patients or those with chronic systemic diseases. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Lower Urinary Tract and Male Genital System, pp. 968-970.

Question 1

A pathologist examines a renal biopsy from a 45-year-old man with nephrotic syndrome and requests a Congo red stain to confirm the nature of amorphous acidophilic extracellular hyaline substances localized within the mesangial matrix of the glomeruli. A positive test confirms the presence of?

Accepted Answer

Amyloid

Answer

Alpha 1-antitrypsin

Answer

Copper

Answer

Glycogen

Question 2

All of the following are true statements about membranous nephropathy except?

Accepted Answer

Granular subendothelial IgG accompanied by C3 deposits

Answer

Irregular 'spikes' on silver staining

Answer

Selective proteinuria

Answer

SLE is a secondary cause

Question 3

Increased renin activity is seen in all of the following conditions, except:

Accepted Answer

Benign nephrosclerosis

Answer

Malignant nephrosclerosis

Answer

Hemolytic Uremic Syndrome

Answer

Juxtaglomerular cell tumor

Question 4

In minimal change disease, why does albumin first appear in the urine?

Accepted Answer

Albumin has a lower molecular weight compared to globulins.

Answer

Albumin has a high affinity to the glomerular basement membrane.

Answer

There is a high albumin:globulin ratio in plasma.

Answer

Albumin undergoes active excretion.

Question 5

Hereditary nephritis is seen in which of the following conditions?

Accepted Answer

Alport syndrome

Answer

Analgesic nephropathy

Answer

Balkan nephropathy

Answer

Eosinophilic nephritis

Question 6

You are examining a nephrectomy specimen diagnosed as renal cell carcinoma. On microscopic examination, the tumor cells contain glycogen and lipids. What is the most likely diagnosis?

Accepted Answer

Clear cell carcinoma

Answer

Papillary carcinoma

Answer

Chromophobe renal carcinoma

Answer

Collecting duct carcinoma

Question 7

The most characteristic finding in diabetic nephropathy is:

Accepted Answer

Nodular glomerulosclerosis

Answer

Diffuse glomerulosclerosis

Answer

Armanni-Ebstein reaction

Answer

Fibrin caps

Question 8

Crescents in renal pathology are derived from which of the following cellular components?

Accepted Answer

Epithelial cells, fibrin, and macrophages

Answer

Mesangial cells, fibrin, and macrophages

Answer

Tubular cells, mesangial cells, and fibrin

Answer

Neutrophils, tubular cells, and fibrin

Question 9

Malakoplakia of the bladder is associated with which of the following?

Accepted Answer

Defect in phagocytosis

Answer

Smoking

Answer

Aniline dye

Answer

Contrast dye

Question 10

All are true about ANCA-associated crescentic glomerulonephritis, except?

Accepted Answer

Seen in Henoch-Schönlein purpura

Answer

Seen in Wegener's granulomatosis

Answer

Seen in microscopic polyangiitis

Answer

Is pauci-immune in nature

Renal Pathology — MCQs

Renal Pathology — MCQs

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