Renal Pathology Practice Questions

Q: A patient presented with pus in urine. Urine culture was negative. Following a sudden onset of renal failure, the patient died. An autopsy revealed the following finding in the kidney. What is the most likely diagnosis?

TB kidney. ***TB kidney*** - **Sterile pyuria** (pus in urine with negative standard culture) is the classic hallmark of **renal tuberculosis**, as TB organisms require special culture media. - Autopsy findings typically show **caseous necrosis**, **cavitation**, and **epithelioid granulomas** with **Langhans giant cells** in the kidney parenchyma. *Infected renal cysts* - Would show **positive bacterial culture** on routine urine culture, not sterile pyuria. - Autopsy would reveal **cystic structures** with **purulent material** but no granulomatous inflammation or caseous necrosis. *Renal cell carcinoma* - Typically presents with **hematuria**, not pyuria, and doesn't cause sterile pyuria. - Autopsy would show **solid tumor mass** with **clear cell** or **papillary architecture**, not inflammatory changes. *Renal stones* - May cause **secondary bacterial infection** leading to positive urine culture, not sterile pyuria. - Autopsy findings would include **calcium oxalate** or **uric acid crystals** with possible **hydronephrosis**, but no granulomatous inflammation.

Q: What is the most common malignant tumor of the kidney?

Renal cell carcinoma. **Explanation:** **Renal Cell Carcinoma (RCC)** is the most common primary malignant tumor of the kidney, accounting for approximately 85–90% of all renal malignancies in adults. It originates from the renal tubular epithelium. Among its various histological subtypes, **Clear Cell Carcinoma** is the most frequent (70–80%), typically associated with deletions on chromosome 3p (VHL gene) [1]. **Analysis of Options:** * **Papillary Adenoma (Option B):** This is the most common **benign** tumor of the kidney [1]. It is often an incidental finding and is histologically defined by a size of less than 1.5 cm. * **Papillary Carcinoma (Option A):** This is the second most common subtype of RCC (approx. 10–15%), but it is not the most common overall malignant tumor [1]. It is frequently associated with trisomy 7 and 17 [1]. * **Wilms Tumor (Option D):** Also known as nephroblastoma, this is the most common renal malignancy in **children** (typically aged 2–5 years), but it is rare in adults. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad:** Hematuria (most common), flank pain, and a palpable abdominal mass (seen in only 10% of cases). * **Risk Factors:** Smoking (most significant), obesity, hypertension, and acquired cystic kidney disease (in dialysis patients). * **Paraneoplastic Syndromes:** RCC is known as the "internist's tumor" because it can secrete hormones leading to Polycythemia (EPO), Hypercalcemia (PTHrP), and Cushing’s Syndrome (ACTH). * **Staging:** The most important prognostic factor is the **TNM stage**, specifically the presence of distant metastasis or renal vein involvement [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 957-961.

Question 1

Organized glomerular deposits are present in which of the following conditions?

Accepted Answer

IgA nephropathy

Answer

Amyloidosis

Answer

Diabetes mellitus

Answer

Cryoglobulinemia

Question 2

A patient presented with pus in urine. Urine culture was negative. Following a sudden onset of renal failure, the patient died. An autopsy revealed the following finding in the kidney. What is the most likely diagnosis?

Accepted Answer

TB kidney

Answer

Infected renal cysts

Answer

Renal cell carcinoma

Answer

Renal stones

Question 3

Which of the following is NOT a feature of acute diffuse proliferative glomerulonephritis?

Accepted Answer

Hypoalbuminemia

Answer

Microscopic hematuria

Answer

Raised blood urea level

Answer

Raised serum creatinine level

Question 4

What is the most common malignant tumor of the kidney?

Accepted Answer

Renal cell carcinoma

Answer

Papillary carcinoma

Answer

Papillary adenoma

Answer

Wilms tumor

Question 5

Which one of the following variants of renal cell carcinoma has the worst prognosis?

Accepted Answer

Sarcomatoid

Answer

Papillary

Answer

Tubuloalveolar

Answer

Chromophobe

Question 6

Renal calculi are commonly made up of which substance?

Accepted Answer

Calcium oxalate

Answer

Magnesium ammonium phosphate

Answer

Uric acid

Answer

Cystine

Question 7

The prognosis is best in rapidly progressive (crescentic) glomerulonephritis associated with which of the following conditions?

Accepted Answer

Poststreptococcal glomerulonephritis

Answer

Systemic lupus erythematosus (SLE)

Answer

Henoch-Schoenlein purpura

Answer

Polyarteritis nodosa

Question 8

Dysmorphic RBCs with acute renal failure (ARF) are typically seen in which condition?

Accepted Answer

Glomerular disease

Answer

Renal carcinoma

Answer

Proximal tubule disease

Answer

Distal tubule disease

Question 9

Post-streptococcal glomerulonephritis (PSGN) is associated with which of the following findings?

Accepted Answer

Subepithelial immune deposits

Answer

Acute renal failure with nephritis

Answer

Low complement levels

Answer

Hypertension and proteinuria

Question 10

A patient presents with hematuria of several days and dysmorphic RBC casts in urine. What is the most likely site of origin for these findings?

Accepted Answer

Kidney

Answer

Ureter

Answer

Bladder

Answer

Urethra

Renal Pathology — MCQs

Renal Pathology — MCQs

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