Renal Pathology Practice Questions

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.

Q: Which condition is characterized by the loss of podocyte foot processes?

Minimal change disease. ***Segmental glomerulosclerosis*** - Characterized by **loss of foot processes** (podocytes) seen on electron microscopy [1][2], leading to **nephrotic syndrome** features. - Common in conditions like **focal segmental glomerulosclerosis (FSGS)** [2][3], associated with various risk factors including **obesity** and **HIV** [1]. *Diabetic nephropathy* - Features **nodular glomerulosclerosis** and **kimmelstiel-wilson nodules**, not specifically loss of foot processes. - Primarily leads to **macroalbuminuria** and later stages cause **end-stage renal disease (ESRD)**. *IgA nephropathy* - Characterized by **IgA deposition** in mesangial areas, leading to **hematuria** and **renal impairment**. - The foot processes remain intact, and it doesn't show the same changes as segmental glomerulosclerosis. *Membranous glomerulitis* - Involves **subepithelial immune complex deposits**, leading to a thickened glomerular membrane without typical foot process loss. - Often presents with **nephrotic syndrome**, but the podocyte foot processes are generally preserved. **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. 531-532. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 927-928. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 530-531.

Q: Which of the following statements about hypernephroma is true?

Not radiosensitive. ***Radiosensitive*** - Hypernephroma, or renal cell carcinoma, is typically resistant to **radiation therapy**, making this statement false. - It is generally treated with **surgery** and targeted therapies rather than radiation. *Usually adenocarcinoma* - Hypernephroma is indeed a type of **adenocarcinoma**, as it originates from the renal tubular epithelium [1]. - It is the most common form of **kidney cancer**, supporting this as a true statement. *May present with rapidly developing varicocele* - Rapidly developing **varicocele** can occur due to **renal vein obstruction** associated with renal tumors [2], so this statement is true. - Varicocele is a recognized clinical feature in renal cell carcinoma due to its anatomical relationships. *Arise from cortex usually from pre existing adenoma* - Hypernephroma does arise from the **renal cortex**, often from pre-existing renal adenomas or other lesions. - This establishes its origin, making the statement accurate. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 959-961. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 492-493.

Q: Which one of the following statements is false about Xanthogranulomatous pyelonephritis in children?

Boys are affected more frequently. ***Boys are affected more frequently*** - This statement is **false** for xanthogranulomatous pyelonephritis (XGP) in children. XGP typically shows a **female predominance** in children, similar to adults. - The disease is more common in girls due to the higher incidence of **urinary tract infections** and **urinary obstruction** in females. *It affects the kidney diffusely more frequently than focally* - This statement is **true**. XGP predominantly presents as a **diffuse disease** affecting the entire kidney in approximately **80-90% of cases**. - **Focal XGP** (10-20% of cases) can occur and may mimic a renal tumor, but diffuse involvement is the classic and more common presentation in both adults and children [1]. *Clinical presentation in children is the same as in adults* - This statement is **true**. Children with XGP often present with similar symptoms to adults, including **fever**, **flank pain**, **recurrent urinary tract infections**, and a **palpable abdominal mass** [1]. - **Failure to thrive** and **anemia** are also common in pediatric cases, reflecting the chronic nature of the infection. *Often affects those younger than 8 years of age* - This statement is **true**. XGP, when it occurs in children, often presents in the **younger age group**, typically before 8 years of age. - This demographic observation highlights the importance of considering XGP in young children with persistent urinary tract symptoms and imaging abnormalities. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 939-940.

Q: Basket weave appearance of glomerular basement membrane on electron microscopy is seen in

Alport syndrome. ***Alport syndrome*** - **Alport syndrome** is characterized by a "basket weave" appearance of the **glomerular basement membrane (GBM)** on electron microscopy due to irregular thickening, thinning, and splitting of the lamina densa. - This structural abnormality results from mutations in genes encoding **Type IV collagen**, particularly **COL4A5**, leading to progressive kidney disease, hearing loss, and ocular abnormalities. *Polyarteritis nodosa* - This is a **necrotizing vasculitis** primarily affecting medium-sized arteries, and its renal involvement typically manifests as a focal or diffuse necrotizing glomerulonephritis, often without specific GBM changes. - The electron microscopic findings would generally show inflammatory cell infiltration and fibrinoid necrosis of vessel walls, not a characteristic GBM pattern. *Giant cell arteritis* - **Giant cell arteritis** is a vasculitis affecting large- and medium-sized arteries, typically in the elderly, and often involves the temporal arteries. - Renal involvement is rare, and the characteristic pathological finding is **granulomatous inflammation** within the arterial wall with giant cells, not GBM changes. *Acute post-streptococcal glomerulonephritis* - This condition is characterized by **subepithelial immune deposits ("humps")** on electron microscopy, not a "basket weave" pattern of the GBM. - The GBM itself may show minor changes but does not exhibit the lamellated and split appearance seen in Alport syndrome.

Q: IgA nephropathy is not associated with which of the following?

Decreased complement level. ***Decreased complement level*** - IgA nephropathy is typically associated with **normal serum complement levels** (C3 and C4), which is an important distinguishing feature. - Unlike post-streptococcal glomerulonephritis or lupus nephritis where complement levels are **low/decreased**, IgA nephropathy does not cause systemic complement consumption. - While complement activation does occur locally in the glomerulus (via lectin and alternative pathways), it does not lead to a decrease in serum complement levels. *Focal mesangial proliferation* - This is a **common histological finding** in IgA nephropathy, reflecting the proliferative response to IgA deposition in the mesangium. - The mesangial cells proliferate in an attempt to clear the immune deposits. *Gross hematuria concurrent with upper respiratory infection* - This is a **classic clinical presentation** of IgA nephropathy, often referred to as **synpharyngitic hematuria**. - The episode of gross hematuria typically occurs **within 1-2 days** of the onset of an upper respiratory tract infection, distinguishing it from post-streptococcal glomerulonephritis where hematuria appears 1-3 weeks later. *Immunofluorescence deposits contain IgA and IgG* - The defining feature of IgA nephropathy on immunofluorescence is the **predominant deposition of IgA**, often accompanied by C3. - While IgA is the primary immunoglobulin, **IgG and IgM can also be present** in variable amounts, but IgA must be the dominant or co-dominant immunoglobulin for the diagnosis.

Q: Subepithelial deposits in the kidney are primarily associated with which condition?

Post-Streptococcal Glomerulonephritis (PSGN). ***PSGN*** - Post-streptococcal glomerulonephritis (PSGN) is characterized by **subepithelial immune complex deposits** [1], typically after a streptococcal infection [1]. - It is associated with **hematuria**, **edema**, and elevated **anti-streptolysin O (ASO)** titers. *GPS* - Minimal change disease (often referred to as idiopathic nephrotic syndrome) does not primarily feature **subepithelial deposits** but rather **effacement of podocyte foot processes**. - Clinical presentation includes **nephrotic syndrome** symptoms, not glomerulonephritis like PSGN. *MPGN-1* - Membranoproliferative glomerulonephritis type 1 includes **subendothelial deposits** rather than subepithelial deposits associated with PSGN. - Symptoms often include **nephritic syndrome** and is commonly linked with conditions like **HCV infection**. *All* - While several conditions can show **deposits in kidney**, not all are characterized by **subepithelial deposits**, hence this option is inaccurate. - Each type of glomerular disease has specific types of deposits (immune complex vs. complement) associated with their pathophysiology. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 914-916.

Q: Characteristic feature of IgA nephropathy?

Serum complement level is normal. ***Serum complement level is normal*** - In **IgA nephropathy**, serum complement levels remain **normal** as this condition is not associated with complement consumption [1]. - This distinguishes it from other glomerulonephritides like **membranoproliferative GN**, where complement levels may be decreased. *Gross hematuria presents after 10 days* - Gross hematuria in IgA nephropathy often occurs **upon infection** or triggers, but not strictly after a set duration like 10 days [1]. - Typically, hematuria is seen with **episodic** flares rather than presenting consistently after a specific time frame. *More common in old age* - IgA nephropathy is actually more common in **young adults**, particularly males, rather than the elderly. - It is not characterized by age but rather often presents in **teenage years to early adulthood**. *It is a type of membranoproliferative GN* - IgA nephropathy is a **separate entity** and is predominantly characterized by the deposition of IgA in the mesangial regions [1], not classified under membranoproliferative GN. - This condition has distinct **pathological features** and immunological characteristics, differentiating it from membranoproliferative forms. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 928-929.

Q: What is the most common nephropathy associated with malignancy?

Membranous glomerulonephritis. ***Membranous glomerulonephritis*** - **Membranous glomerulonephritis** has the strongest and most frequent association with solid organ malignancies, particularly in older patients. - While other glomerulopathies can be linked to cancer, **membranous nephropathy** is the most common paraneoplastic glomerulopathy in adults. *Focal segmental glomerulosclerosis (FSGS)* - While FSGS can be associated with certain cancers, particularly hematological malignancies and HIV-associated nephropathy, it is **less common** than membranous nephropathy in solid tumors. - The link is often with **HIV-associated nephropathy** or direct tumor effects rather than a paraneoplastic syndrome. *Minimal change disease* - Minimal change disease is predominantly seen in **children** and is less frequently associated with malignancy compared to membranous nephropathy. - When associated with malignancy, it is typically with **lymphoproliferative disorders** like Hodgkin lymphoma. *IgA nephropathy* - **IgA nephropathy** is the most common primary glomerulonephritis worldwide but has a **weak and inconsistent association** with malignancy. - Its presence alongside cancer is often coincidental rather than directly causative.

Question 1

Nephrocalcinosis is seen in all except

Accepted Answer

Polycystic kidney

Answer

Hyperparathyroidism

Answer

Medullary sponge kidney

Answer

Renal tubular acidosis

Question 2

Which condition is characterized by the loss of podocyte foot processes?

Accepted Answer

Minimal change disease

Answer

Focal segmental glomerulosclerosis

Answer

Membranous nephropathy

Answer

IgA vasculitis

Question 3

Which of the following is NOT a recognized cause of Urothelial Carcinomas?

Accepted Answer

Alcohol consumption

Answer

Industrial solvents

Answer

Exposure to thorotrast

Answer

Smoking

Question 4

Which of the following statements about hypernephroma is true?

Accepted Answer

Not radiosensitive

Answer

May present with rapidly developing varicocele

Answer

Usually an adenocarcinoma

Answer

Arises from the cortex, usually from a pre-existing adenoma

Question 5

Which one of the following statements is false about Xanthogranulomatous pyelonephritis in children?

Accepted Answer

Boys are affected more frequently

Answer

Clinical presentation in children is the same as in adults

Answer

Often affects those younger than 8 years of age

Answer

It affects the kidney diffusely more frequently than focally

Question 6

Basket weave appearance of glomerular basement membrane on electron microscopy is seen in

Accepted Answer

Alport syndrome

Answer

Polyarteritis nodosa

Answer

Giant cell arteritis

Answer

Acute post-streptococcal glomerulonephritis

Question 7

IgA nephropathy is not associated with which of the following?

Accepted Answer

Decreased complement level

Answer

Focal mesangial proliferation

Answer

Gross hematuria concurrent with upper respiratory infection

Answer

Immunofluorescence deposits contain IgA and IgG

Question 8

Subepithelial deposits in the kidney are primarily associated with which condition?

Accepted Answer

Post-Streptococcal Glomerulonephritis (PSGN)

Answer

None of these conditions are associated with subepithelial deposits.

Answer

Membranoproliferative Glomerulonephritis (MPGN) Type I

Answer

Goodpasture's Syndrome (GPS)

Question 9

Characteristic feature of IgA nephropathy?

Accepted Answer

Serum complement level is normal

Answer

More common in old age

Answer

It is a type of membranoproliferative GN

Answer

Gross hematuria presents after 10 days

Question 10

What is the most common nephropathy associated with malignancy?

Accepted Answer

Membranous glomerulonephritis

Answer

Focal segmental glomerulosclerosis (FSGS)

Answer

Minimal change disease

Answer

IgA nephropathy

Renal Pathology — MCQs

Renal Pathology — MCQs

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