Renal Pathology Practice Questions

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.

Q: Presence of which of the following in the urine is diagnostic of glomerular injury?

20% dysmorphic RBCs. The presence of **dysmorphic Red Blood Cells (RBCs)** in the urine is a hallmark of **glomerular bleeding** [1]. When RBCs pass through the damaged glomerular basement membrane (GBM) and travel through the varying osmotic gradients of the renal tubules, they undergo mechanical and chemical stress. This results in distorted shapes, such as blebs, protrusions, or fragmented membranes [1]. * **Why Option B is correct:** While various thresholds exist, the presence of **>20% dysmorphic RBCs** (or specifically **>5% Acanthocytes/G1 cells**) is highly specific for a glomerular source of hematuria (e.g., Glomerulonephritis). Acanthocytes, which are ring-shaped RBCs with vesicle-like protrusions, are the most reliable markers [1]. * **Why Option A is incorrect:** Bright red cells (isomorphic RBCs) usually indicate **non-glomerular bleeding** from the lower urinary tract (ureters, bladder, or urethra), such as from stones, trauma, or malignancy [1]. * **Why Option C is incorrect:** The quantity of RBCs (100 RBCs/HPF) indicates the severity of hematuria but does not localize the site of injury. Both glomerular and post-glomerular pathologies can cause high-grade hematuria [1]. * **Why Option D is incorrect:** Beta-2 microglobulin is a low-molecular-weight protein. Increased levels in the urine are a marker of **tubular injury** (proximal tubule dysfunction), not glomerular injury. **High-Yield Clinical Pearls for NEET-PG:** * **Red Cell Casts:** These are 100% pathognomonic for glomerular hematuria [1]. * **Acanthocytes:** Specifically, the "Mickey Mouse" appearance of RBCs is the most specific type of dysmorphic cell for glomerulonephritis. * **Glomerular vs. Non-Glomerular:** Glomerular hematuria is often associated with significant proteinuria (>500 mg/day) and a "smoky" or "cola-colored" urine appearance, whereas non-glomerular hematuria often presents with blood clots [1].

Q: Which of the following diseases is characterized by the features presented?

Systemic Lupus Erythematosus (SLE). ***Systemic Lupus Erythematosus (SLE)*** - **Wire-loop lesions** on renal biopsy are pathognomonic of **lupus nephritis**, specifically seen in Class IV diffuse endocapillary/extracapillary proliferative glomerulonephritis - The characteristic **subendothelial immune complex deposits** create the distinctive wire-loop appearance under light microscopy, indicating active **Type III hypersensitivity** reaction *Rheumatoid Arthritis (RA)* - Primarily affects **synovial joints** with pannus formation, not typically associated with glomerular wire-loop lesions - Renal involvement in RA is usually secondary to **drug toxicity** (NSAIDs, DMARDs) rather than immune complex nephritis *Autoimmune hepatitis* - Characterized by **hepatocellular necrosis** and **portal inflammation** with plasma cell infiltration in liver tissue - Does not cause **glomerular pathology** or wire-loop lesions, as it primarily targets hepatocytes *Human Immunodeficiency Virus (HIV)* - Associated with **HIV-associated nephropathy (HIVAN)** showing collapsing focal segmental glomerulosclerosis, not wire-loop lesions - Causes **immunosuppression** rather than autoimmune complex-mediated glomerular damage typical of SLE

Question 1

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 2

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 3

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

Question 4

What is the condition characterized by the triad of glomerulonephritis, pulmonary hemorrhages, and the presence of antibody to the basement membrane?

Accepted Answer

Goodpasture syndrome

Answer

Systemic Necrotizing Vasculitis

Answer

Mixed connective tissue disease

Answer

Diabetic nephropathy

Question 5

Presence of which of the following in the urine is diagnostic of glomerular injury?

Accepted Answer

20% dysmorphic RBCs

Answer

Bright red cells

Answer

100 RBCs per high power field

Answer

Beta-2 microglobulin

Question 6

What is the most common malignant tumor of the kidney in children?

Accepted Answer

Wilms tumor

Answer

Neuroblastoma

Answer

Polycystic kidney disease

Answer

Angioliposarcoma

Question 7

Which type of Focal Segmental Glomerulosclerosis (FSGS) has the worst prognosis?

Accepted Answer

Collapsing

Answer

Tip variant

Answer

NOS (Not Otherwise Specified)

Answer

Perihilar

Question 8

Which of the following diseases is characterized by the features presented?

Accepted Answer

Systemic Lupus Erythematosus (SLE)

Answer

Rheumatoid Arthritis (RA)

Answer

Autoimmune hepatitis

Answer

Human Immunodeficiency Virus (HIV)

Question 9

A 45-year-old man has had poorly controlled hypertension for the past 11 years, with readings ranging from 150/90 mm Hg to 160/95 mm Hg. Over the last 3 months, his blood pressure has increased to 250/125 mm Hg. On physical examination, his temperature is 36.9°C, lungs are clear on auscultation, heart rate is regular, and there is no abdominal pain on palpation. A chest radiograph shows a prominent border on the left side of the heart. Laboratory studies show that his serum creatinine level has increased during this time from 1.7 mg/dL to 3.8 mg/dL. Which of the following vascular lesions is most likely to be found in this patient's kidneys?

Accepted Answer

Necrotizing arteriolitis

Answer

Fibromuscular dysplasia

Answer

Granulomatous arteritis

Answer

Renal arterial stenosis

Question 10

In Wegener's granulomatosis, what are the characteristic histopathological features seen in the glomeruli?

Accepted Answer

Focal necrotizing glomerulonephritis

Answer

Granulomas in the vessel walls

Answer

Interstitial granulomas

Answer

Nodular glomerulosclerosis

Renal Pathology — MCQs

Renal Pathology — MCQs

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