Renal Pathology Practice Questions

Q: Loss of foot processes of podocytes is characteristically seen in which condition?

Lipoid nephrosis. **Explanation:** **Lipoid nephrosis**, also known as **Minimal Change Disease (MCD)**, is the most common cause of nephrotic syndrome in children [1]. The hallmark of this condition is the **effacement (loss/fusion) of foot processes of podocytes**, which is visible only under **Electron Microscopy (EM)** [1]. Light microscopy typically appears normal, and Immunofluorescence (IF) is negative [1]. The loss of these foot processes leads to the disappearance of the slit diaphragm, resulting in massive selective proteinuria (primarily albumin) [1]. **Analysis of Incorrect Options:** * **Goodpasture Syndrome:** Characterized by anti-GBM antibodies. Light microscopy shows **crescentic formation** (RPGN), and IF shows **linear IgG deposits** along the basement membrane. * **Post-streptococcal Glomerulonephritis (PSGN):** An immune-complex mediated disease. EM characteristically shows **subepithelial "humps"**, and IF shows a "starry sky" or granular pattern. * **Lupus Nephritis:** A complex systemic condition where EM typically shows **subendothelial deposits** (Wire-loop lesions in Class IV) and a "Full House" pattern on IF. **High-Yield Clinical Pearls for NEET-PG:** * **MCD** is the most common nephrotic syndrome in children; **FSGS** is the most common in adults (though FSGS also shows foot process effacement, it is focal and segmental). * MCD is highly responsive to **Corticosteroids** [1]. * The proteinuria in MCD is **highly selective** (Albuminuria) [1]. * Association: MCD can be associated with **Hodgkin Lymphoma** in adults (due to cytokine release). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 927-928.

Q: Hobnail pattern is seen in which type of Renal Cell Carcinoma?

Collecting duct. **Explanation:** The **Collecting Duct Carcinoma (CDC)**, also known as Bellini duct carcinoma, is a rare but highly aggressive subtype of Renal Cell Carcinoma (RCC) arising from the distal segment of the collecting ducts. **Why the correct answer is right:** The characteristic histological feature of CDC is a **tubulopapillary architecture** lined by highly atypical cells. These cells exhibit a **"Hobnail appearance,"** where the nuclei bulge into the lumen of the tubules or papillae due to a high nuclear-to-cytoplasmic ratio and apical displacement. This pattern is a classic morphologic hallmark used to differentiate it from other renal tumors. **Why the incorrect options are wrong:** * **Clear cell RCC:** The most common type; characterized by cells with clear cytoplasm (due to glycogen and lipid) and a prominent delicate vascular network ("chicken-wire" pattern) [1]. * **Papillary RCC:** Characterized by papillae with fibrovascular cores containing **foamy macrophages** and psammoma bodies [1]. * **Chromophobe RCC:** Features large polygonal cells with prominent cell membranes (**"vegetable cell" appearance**), perinuclear halos, and "raisinoid" nuclei [1]. It stains positive with **Hale’s Colloidal Iron**. **High-Yield Clinical Pearls for NEET-PG:** * **Origin:** Medulla (unlike Clear cell/Papillary which arise from the Proximal Convoluted Tubule). * **Prognosis:** Extremely poor; most patients present with metastatic disease. * **Immunohistochemistry:** CDC is often positive for **High Molecular Weight Cytokeratin (HMWK)** and Ulex europaeus agglutinin-1 (UEA-1). * **Differential Diagnosis:** Medullary carcinoma (associated with Sickle Cell Trait) also shows hobnailing but is distinguished by its association with hemoglobinopathies. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 959-961.

Question 1

A young child presented with a history of dark-colored urine and reduced urine output. The child had a past history of abdominal pain, fever, and bloody diarrhea for 4 days, which resolved spontaneously. There was no peripheral edema or rashes. Investigations revealed anemia, thrombocytopenia, and elevated blood urea nitrogen and serum creatinine. Which of the following findings is most expected in this patient?

Accepted Answer

Elevated serum indirect bilirubin

Answer

Elevated haptoglobin level

Answer

Elevated thrombin and prothrombin time

Answer

Low fibrinogen and elevated D-dimer level

Question 2

A wire loop lesion seen in lupus nephritis is due to which of the following?

Accepted Answer

Capillary wall thickening

Answer

Basement membrane thickening

Answer

Subepithelial deposits

Answer

Sclerosis of mesangium

Question 3

Hypercalcemia is a known complication in which type of cancer?

Accepted Answer

Renal cell carcinoma

Answer

Carcinoma of the stomach

Answer

Small cell carcinoma of the lung

Answer

Hepatocellular carcinoma

Question 4

Transitional cell carcinoma of the bladder is associated with which of the following?

Accepted Answer

All of the above

Answer

Schistosomiasis

Answer

Naphthylamine

Answer

Smoking

Question 5

Glomerulonephritis is due to what mechanism?

Accepted Answer

Immune complex deposition

Answer

Type I hypersensitivity reaction

Answer

Type IV hypersensitivity reaction

Answer

Type V hypersensitivity reaction

Question 6

Loss of foot processes of podocytes is characteristically seen in which condition?

Accepted Answer

Lipoid nephrosis

Answer

Goodpasture syndrome

Answer

Post-streptococcal glomerulonephritis (PSGN)

Answer

Lupus nephritis

Question 7

Hobnail pattern is seen in which type of Renal Cell Carcinoma?

Accepted Answer

Collecting duct

Answer

Clear cell

Answer

Papillary

Answer

Chromophobe

Question 8

Type I RPGN is seen in which of the following conditions?

Accepted Answer

Goodpasture's syndrome

Answer

Cryoglobulinemia

Answer

SLE

Answer

Wegner's granulomatosis

Question 9

Nephrotic syndrome is characterised by which of the following?

Accepted Answer

All of the above

Answer

Proteinuria

Answer

Hyperlipidemia

Answer

Oedema

Question 10

According to the WHO classification, which class of membranous glomerulonephritis is typically seen in Systemic Lupus Erythematosus (SLE)?

Accepted Answer

Class V

Answer

Class II

Answer

Class III

Answer

Class IV

Renal Pathology — MCQs

Renal Pathology — MCQs

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