Renal Pathology Practice Questions

Q: Loss of foot process is classical in case of?

Segmental glomerulosclerosis. ***Segmental glomerulosclerosis*** - Characterized by a **loss of foot processes**, leading to a "focal" or "segmental" pattern of sclerosis on histology [1][2]. - Often presents with **nephrotic syndrome**, including proteinuria and edema, due to damage to the glomeruli [1][3]. *Membranous glomerulitis* - Primarily involves **thickening of the glomerular capillary walls** without the loss of foot processes initially. - It is often associated with **membrane antibodies** and can lead to nephrotic syndrome, but not specifically linked to foot process loss [2]. *Diabetic nephropathy* - Characterized by **nodular glomerulosclerosis** and other microvascular changes, but the loss of foot processes is not a classic feature. - Typically presents with **diffuse glomerular basement membrane thickening** and eventual renal failure. *IgA nephropathy* - Characterized by the deposition of **IgA antibodies** in the mesangial area, leading to hematuria but not directly causing loss of foot processes. - Symptoms often include **recurrent episodes of hematuria** which can be triggered by infection, rather than nephrotic syndrome. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 927-928. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 530-532. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, p. 913.

Q: A 51-year-old person came with a complaint of hematuria. On examination, he was normotensive and had pedal edema. Investigations revealed the patient had no glucosuria and had a creatinine value of 9mg%. Renal biopsy is as shown below. Which of the following investigations should be done to identify the etiology of the disease?

ANTI GBM antibodies. ***ANTI GBM antibodies*** - A renal biopsy showing glomerular damage and hematuria suggests possible **Goodpasture's syndrome** or **anti-GBM disease**, where **anti-GBM antibodies** would be present [1][2]. - Testing for these antibodies helps confirm the diagnosis and directs appropriate treatment [2][3]. *ANA* - **Antinuclear antibodies (ANA)** are primarily associated with autoimmune conditions like **lupus**, which typically presents with other systemic symptoms. - In this case, lacking **other symptoms** like joint pain or rashes reduces the relevance of this test for hematuria and renal issues. *HIV RNA* - While **HIV** can affect kidney function and lead to complications like **HIV-associated nephropathy**, it is not the primary investigation for isolated hematuria and elevated creatinine. - This test would be more relevant in cases where there is a known risk factor or acute process indicating possible infection. *Urine immunoelectrophoresis* - This test is mainly used for detecting **monoclonal proteins** in conditions like **multiple myeloma** or to evaluate for **paraproteinemia**. - It is not directly useful in identifying the etiology of glomerular diseases associated with hematuria and would not provide the necessary information. **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. 526-527. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 537-538. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 918-919.

Q: Struvite stones are primarily composed of which metal?

Magnesium. ***Magnesium*** - **Struvite stones** are primarily composed of **magnesium ammonium phosphate**, formed in the presence of urease-producing bacteria. - The presence of magnesium is a defining component of these **infection-related stones**. *Calcium* - **Calcium** is the primary component of the most common type of kidney stones, **calcium oxalate** and **calcium phosphate stones**. - These are typically unrelated to bacterial infections, unlike struvite stones. *Sodium* - **Sodium** is not a primary component of any common type of kidney stone. - While high sodium intake can increase the risk of stone formation, it does not directly form the stone matrix. *Potassium* - **Potassium** is not a characteristic component of kidney stones. - It plays a role in urinary pH regulation but is not directly incorporated into stone formation.

Q: Which of the following is not a feature of Minimal change disease?

Hypertension. ***Hypertension*** - Hypertension is not typically associated with **Minimal Change Disease** (MCD), as it primarily presents with nephrotic syndrome features [1]. - MCD is characterized by **normal blood pressure**, making this correct as it is not a feature of the disease [1]. *Proteinuria* - Proteinuria is a hallmark of **Minimal Change Disease**, often presenting as **nephrotic range proteinuria** [1]. - This condition involves significant loss of **albumin** in the urine, directly contradicting the option statement [1]. *Edema* - Edema is commonly seen in patients with **Minimal Change Disease**, primarily due to fluid retention from low serum albumin levels. - The **peripheral edema** often presents alongside other nephrotic syndrome features, thus making it a typical symptom. *Responsive to steroid therapy* - **Minimal Change Disease** is known for its excellent response to **steroids**, which is a key feature of this condition [1]. - Most patients show dramatic improvement with corticosteroid treatment, confirming this option is also incorrect [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 922-923.

Q: In a patient diagnosed with Autosomal Recessive Polycystic Kidney Disease (ARPKD), which protein is primarily altered due to mutations in the PKHD1 gene?

Fibrocystin. ***Fibrocystin*** - Autosomal recessive polycystic kidney disease (ARPKD) is primarily associated with the altered expression of **fibrocystin**, which is crucial for kidney development [1]. - Mutations in the *PKHD1* gene, responsible for fibrocystin, lead to the characteristic cyst formation in the kidneys [1]. *Polycystin* - Polycystin is related to autosomal dominant polycystic kidney disease (ADPKD), not ARPKD. - ADPKD is linked to mutations in the *PKD1* and *PKD2* genes, primarily affecting adult populations. *Uromodulin* - Uromodulin is predominantly expressed in the thick ascending limb of the loop of Henle and is linked to **medullary cystic kidney disease**, not ARPKD. - Its role is associated with urine concentration and is not directly involved in the pathogenesis of ARPKD. *Nephrocystin* - Nephrocystin is associated with nephronophthisis, which is a different cystic kidney disease. - It primarily impacts the ciliopathic pathways and kidney function, unlike fibrocystin's role in ARPKD. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 952-953.

Q: In a patient with nephrotic syndrome, which antibody is decreased?

IgG. ***IgG*** - In **nephrotic syndrome**, the kidneys' glomerular basement membrane becomes highly permeable, leading to a significant loss of plasma proteins into the urine [1]. - **IgG** is the smallest and most abundant immunoglobulin, making it particularly susceptible to urinary loss due to its size, leading to decreased serum levels. *IgE* - **IgE** levels are not typically decreased in nephrotic syndrome; its primary role is in allergic reactions and parasite defense, and it is not significantly lost in urine. - While other proteins are lost, the relatively low concentration and functional role of IgE mean its depletion is not a characteristic feature of nephrotic syndrome. *IgM* - **IgM** is a large pentameric antibody and, due to its substantial size, it is generally retained in the bloodstream even when the glomerular filtration barrier is compromised in nephrotic syndrome [1]. - Its large molecular weight makes it less likely to be filtered and excreted in the urine compared to smaller proteins like albumin and IgG [2]. *IgA* - **IgA** exists as a monomer in serum and as a dimer in mucosal secretions. While smaller than IgM, it is still larger than IgG and is not characteristically decreased in nephrotic syndrome due to urinary loss. - Decreased IgA levels are more commonly associated with selective IgA deficiency, a primary immunodeficiency, rather than the non-selective protein loss of nephrotic syndrome.

Q: Histopathology showing large cells with plant-like appearance and a perinuclear halo is seen in which type of renal cell carcinoma?

Chromophobic. ***Chromophobic*** - Characterized by **large cells** with a **plant-like appearance** and a **perinuclear halo**, consistent with chromophobic renal cell carcinoma [1]. - This type of carcinoma typically shows **foamy cytoplasm** due to the presence of abundant glycogen and lesser degree of nuclear atypia [1]. *Granular cell carcinoma* - This carcinoma features **eosinophilic** granular cytoplasm, not the **plant-like appearance** described in the question. - Granular cells are more often associated with **chromophobe cells**, but do not present with a perinuclear halo. *Angiosarcoma* - Angiosarcoma is characterized by **pleomorphic vascular formations** and does not display the **large cells** or halo appearance. - It typically shows a **high mitotic rate** and is associated with **vascular invasion**, distinguishing it from chromophobic carcinoma. *Onchocytoma* - Onchocytomas present with **large eosinophilic cells** due to mitochondrial proliferation and do not demonstrate the plant-like appearance or perinuclear halo [1]. - They usually do not have significant atypia or necrosis, unlike chromophobic renal cell carcinoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, p. 959.

Q: Which of the following statements about Renal Cell Carcinoma (RCC) is true?

Invasion of renal vein is more common than renal artery. ***Invasion of renal vein is more common than renal artery*** - Renal cell carcinoma (RCC) is known for its tendency to invade the **renal vein** more frequently, leading to **thrombus formation** [1]. - This feature contributes to the risk of **venous metastasis**, which enhances its aggressive nature. *Most common site of metastasis is lymph nodes* - While RCC can metastasize to lymph nodes, the **most common sites** are actually the lungs and bones. - **Lymphatic spread** is less typical, as hematogenous spread is the preferred route for metastasis in RCC. *Most common site is lower lobe of kidney* - RCC can originate in any part of the kidney, with **upper pole involvement** being more common than the lower lobe. - It commonly presents as a mass rather than a site-specific condition within the kidney. *Most common variety is papillary type* - The most frequent subtype of RCC is **clear cell carcinoma** [1], not papillary, which accounts for approximately 70-80% of cases. - Papillary RCC is indeed a type but is **less prevalent**, making this statement incorrect. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 959-961.

Q: Nephrocalcinosis is seen in all except

Polycystic kidney. ***Polycystic kidney*** - Nephrocalcinosis typically does not occur in **polycystic kidney disease**, which is characterized by cyst formation rather than calcium deposition. - The condition is mainly associated with **enlarged kidneys** and a **genetic predisposition** rather than calcium accumulation in the renal parenchyma. *Renal tubular acidosis* - Renal tubular acidosis can lead to **metabolic acidosis**, which may promote calcium deposition and consequent nephrocalcinosis. - In this condition, impaired renal tubular function causes **uncontrolled calcium excretion** and urine pH abnormalities. *Hyperparathyroidism* - In hyperparathyroidism, **elevated calcium levels** lead to increased nephrocalcinosis as calcium is deposited in the renal tissues [1][2]. - It results in **bone resorption** and may manifest with kidney stones, indicating the renal involvement [2]. *Medullary sponge kidney* - Medullary sponge kidney frequently leads to **calcium deposits** in the renal medulla, resulting in nephrocalcinosis. - This condition is characterized by cystic dilation of collecting tubules, causing **stasis of urine** and calcium accumulation. **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. 539-540. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1105-1106.

Question 1

A 40-year-old woman with systemic lupus erythematosus (SLE) presents with symptoms including proteinuria, edema, and hypertension. What is the most likely renal pathology associated with her condition?

Accepted Answer

Glomerulonephritis leading to protein loss, fluid retention, and hypertension

Answer

Tubulointerstitial nephritis causing electrolyte imbalance and hypovolemia

Answer

Chronic pyelonephritis leading to decreased renal function and hyperkalemia

Answer

Renal vasculitis causing ischemic damage and acute tubular necrosis

Question 2

Loss of foot process is classical in case of?

Accepted Answer

Segmental glomerulosclerosis

Answer

Diabetic nephropathy (later stages)

Answer

Membranous nephropathy

Answer

IgA vasculitis

Question 3

A 51-year-old person came with a complaint of hematuria. On examination, he was normotensive and had pedal edema. Investigations revealed the patient had no glucosuria and had a creatinine value of 9mg%. Renal biopsy is as shown below. Which of the following investigations should be done to identify the etiology of the disease?

Accepted Answer

ANTI GBM antibodies

Answer

ANA

Answer

HIV RNA

Answer

Urine immunoelectrophoresis

Question 4

Struvite stones are primarily composed of which metal?

Accepted Answer

Magnesium

Answer

Calcium

Answer

Sodium

Answer

Potassium

Question 5

Which of the following is not a feature of Minimal change disease?

Accepted Answer

Hypertension

Answer

Edema

Answer

Responsive to steroid therapy

Answer

Proteinuria

Question 6

In a patient diagnosed with Autosomal Recessive Polycystic Kidney Disease (ARPKD), which protein is primarily altered due to mutations in the PKHD1 gene?

Accepted Answer

Fibrocystin

Answer

Polycystin

Answer

Nephrocystin

Answer

Uromodulin

Question 7

In a patient with nephrotic syndrome, which antibody is decreased?

Accepted Answer

IgG

Answer

IgE

Answer

IgM

Answer

IgA

Question 8

Histopathology showing large cells with plant-like appearance and a perinuclear halo is seen in which type of renal cell carcinoma?

Accepted Answer

Chromophobic

Answer

Granular cell carcinoma

Answer

Clear cell RCC

Answer

Papillary RCC

Question 9

Which of the following statements about Renal Cell Carcinoma (RCC) is true?

Accepted Answer

Invasion of renal vein is more common than renal artery

Answer

Most common site is upper pole of kidney

Answer

Most common site of metastasis is liver

Answer

Most common variety is papillary type

Question 10

Nephrocalcinosis is seen in all except

Accepted Answer

Polycystic kidney

Answer

Hyperparathyroidism

Answer

Medullary sponge kidney

Answer

Renal tubular acidosis

Renal Pathology — MCQs

Renal Pathology — MCQs

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