Renal Pathology Practice Questions

Q: Which is usually a presentation of the condition shown in the immunofluorescence study of the kidney?

Development of renal vein thrombosis. ***Development of renal vein thrombosis*** - **Membranous nephropathy** causes severe **nephrotic syndrome** with massive proteinuria, leading to loss of **antithrombin III** and increased hypercoagulability. - **Renal vein thrombosis** is a classic and serious complication, occurring in up to 25% of patients with membranous nephropathy due to the hypercoagulable state. *Steroid responsive selective proteinuria* - This describes **minimal change disease**, which shows **effacement of podocyte foot processes** on electron microscopy, not granular IgG deposits. - Minimal change disease has **negative immunofluorescence**, unlike the granular pattern seen in membranous nephropathy. *Nephelometer assay showing increased serum free light chain* - This finding suggests **plasma cell dyscrasia** or **multiple myeloma**, which can cause **light chain deposition disease**. - Light chain nephropathy shows **linear or nodular deposits** of light chains, not the **granular IgG pattern** characteristic of membranous nephropathy. *Fibrillary immunotactoid glomerulopathy* - This rare condition shows **organized fibrillar deposits** on electron microscopy with **polyclonal IgG staining**. - Unlike membranous nephropathy, it typically presents with **nephritic features** including hematuria and hypertension, rather than pure nephrotic syndrome.

Q: A patient presents with one normal kidney and the contralateral kidney appearing contracted with evidence of scarring. What is the most probable diagnosis?

Chronic pyelonephritis. ### Explanation **Correct Option: A. Chronic pyelonephritis** Chronic pyelonephritis (CPN) is a leading cause of **asymmetric renal disease** [1]. It is characterized by irregular, coarse, U-shaped corticomedullary scarring overlying a dilated, blunted, or deformed calyx [1]. Because the underlying causes—such as vesicoureteral reflux (VUR) or localized obstruction—often affect one kidney more severely than the other, it typically presents as a **contracted, scarred kidney** on one side with a relatively normal (or compensatorily enlarged) contralateral kidney [1]. **Why other options are incorrect:** * **B. Polycystic Kidney Disease (ADPKD):** This is a **bilateral** genetic condition. Both kidneys are typically massively enlarged with numerous cysts, rather than being small and contracted. * **C. Renal Artery Stenosis:** While this can cause a small, shrunken kidney (Goldblatt kidney) due to ischemia, the kidney surface is usually **smoothly** atrophic rather than coarsely scarred. * **D. Tuberculosis of the Kidney:** While TB can cause scarring (Putty kidney), it is usually associated with caseous necrosis and "autonephrectomy." However, the classic "contracted and scarred" description in a unilateral context is the hallmark of CPN in pathology exams. **NEET-PG High-Yield Pearls:** * **Asymmetric involvement:** The most important clue for Chronic Pyelonephritis is asymmetry [1]. * **Thyroidization of tubules:** On histology, tubules are dilated and filled with eosinophilic casts, resembling thyroid follicles [1]. * **U-shaped scars:** These are the pathognomonic gross findings of CPN, distinguishing it from the V-shaped scars of healed infarcts [1]. * **Reflux Nephropathy:** The most common cause of chronic pyelonephritis in children [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 937-940.

Question 1

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 2

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 3

Polycystic kidney disease is most commonly inherited in which pattern?

Accepted Answer

Autosomal dominant

Answer

Autosomal recessive

Answer

X-linked recessive

Answer

Sporadic

Question 4

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 5

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

Question 6

Which is usually a presentation of the condition shown in the immunofluorescence study of the kidney?

Accepted Answer

Development of renal vein thrombosis

Answer

Steroid responsive selective proteinuria

Answer

Nephelometer assay showing increased serum free light chain

Answer

Fibrillary immunotactoid glomerulopathy

Question 7

Birefringent crystals in urine are seen with which of the following?

Accepted Answer

Calcium oxalate stones

Answer

Uric acid stones

Answer

Struvite stones

Answer

None of the above

Question 8

Renal biopsy demonstrates concentric, laminated thickening of arteriolar walls due to proliferation of smooth muscle cells. This process is best described by which of the following terms?

Accepted Answer

Hyperplastic arteriolosclerosis

Answer

Atherosclerosis

Answer

Hyaline arteriolosclerosis

Answer

Monckeberg's arteriosclerosis

Question 9

Which of the following is the characteristic histological feature of HIV-associated collapsing glomerulopathy?

Accepted Answer

Hypertrophy and proliferation of visceral epithelial cells

Answer

Crescent formation

Answer

Mesangial deposition

Answer

Subepithelial deposition with endothelial cell proliferation

Question 10

A patient presents with one normal kidney and the contralateral kidney appearing contracted with evidence of scarring. What is the most probable diagnosis?

Accepted Answer

Chronic pyelonephritis

Answer

Polycystic kidney disease

Answer

Renal artery stenosis

Answer

Tuberculosis of the kidney

Renal Pathology — MCQs

Renal Pathology — MCQs

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