Renal Pathology Practice Questions

Q: A characteristic electron microscopic feature of minimal change disease is:

Fusion of foot processes and their effacement. ### Explanation **Minimal Change Disease (MCD)** is the most common cause of nephrotic syndrome in children [1]. The hallmark of this condition is that the kidney appears normal under Light Microscopy (LM) and Immunofluorescence (IF), but reveals diagnostic changes under Electron Microscopy (EM) [1]. **Why Option C is Correct:** The primary pathology in MCD is **podocyte injury** (podocytopathy). On EM, the most characteristic feature is the **diffuse effacement (flattening) and fusion of the foot processes** of visceral epithelial cells (podocytes) [1]. This leads to the loss of the anionic charge barrier (polyatomic charge), resulting in selective proteinuria (mainly albuminuria) [1]. **Analysis of Incorrect Options:** * **Option A (Mesangial deposits):** These are characteristic of **IgA Nephropathy** or certain stages of Lupus Nephritis, not MCD. * **Option B (Splitting of basement membrane):** This "tram-track" appearance is a classic feature of **Membranoproliferative Glomerulonephritis (MPGN)** or Alport Syndrome [1]. * **Option C (Subepithelial deposits):** These "humps" or "spikes" are seen in **Post-Streptococcal Glomerulonephritis (PSGN)** or **Membranous Nephropathy**, respectively. MCD is characterized by the *absence* of electron-dense deposits [1]. **NEET-PG High-Yield Pearls:** * **Light Microscopy:** Glomeruli appear completely normal (hence the name "Minimal Change") [1]. * **Immunofluorescence:** Negative (no immune complex deposits) [1]. * **Clinical Presentation:** Sudden onset of massive edema; **highly steroid-responsive.** * **Association:** Can be associated with **Hodgkin Lymphoma** in adults (due to T-cell dysfunction/cytokine release). * **Proteinuria:** Classically described as **highly selective** (albumin only) [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 927-928.

Q: Hypercoagulation in nephrotic syndrome is caused by?

Loss of antithrombin III. **Explanation:** Nephrotic syndrome is characterized by massive proteinuria (>3.5g/day) due to increased glomerular permeability. This leads to a **hypercoagulable state**, significantly increasing the risk of venous thromboembolism (e.g., Renal Vein Thrombosis). **1. Why Option A is Correct:** The primary mechanism for hypercoagulation is the **urinary loss of low-molecular-weight anticoagulant proteins**, most notably **Antithrombin III (ATIII)**. ATIII is a natural anticoagulant that inhibits thrombin and factors IXa, Xa, XIa, and XIIa. Its depletion shifts the hemostatic balance toward thrombosis. Additionally, the liver increases the synthesis of pro-coagulant factors (like Factor V and Fibrinogen) in a compensatory response to low oncotic pressure. **2. Why the other options are incorrect:** * **Option B:** Fibrinogen levels are actually **increased** (not decreased) in nephrotic syndrome due to reactive hepatic synthesis, contributing to hyperviscosity. * **Option C:** Vitamin K metabolism is not directly affected by the pathophysiology of nephrotic syndrome. * **Option D:** Levels of **Protein C and Protein S** are typically **decreased** (due to urinary loss), not increased [1]. An increase in these proteins would provide an anticoagulant effect, which contradicts the clinical presentation. **NEET-PG High-Yield Pearls:** * **Renal Vein Thrombosis (RVT):** Most commonly associated with **Membranous Nephropathy** in adults. * **Clinical Sign:** Sudden onset of flank pain and hematuria in a nephrotic patient suggests RVT. * **Other factors:** Hyperlipidemia and increased platelet aggregation also contribute to the pro-thrombotic state in these patients. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Hemodynamic Disorders, Thromboembolic Disease, and Shock, pp. 133-134.

Question 1

A characteristic electron microscopic feature of minimal change disease is:

Accepted Answer

Fusion of foot processes and their effacement

Answer

Mesangial deposits

Answer

Splitting of basement membrane

Answer

Subepithelial deposits

Question 2

In which of the following conditions are linear IgA deposits in the mesangium noted?

Accepted Answer

Henoch Schonlein purpura

Answer

Malaria

Answer

Good Pasture's syndrome

Answer

Wegener's granulomatosis

Question 3

Papillary necrosis is most commonly seen in?

Accepted Answer

Analgesic nephropathy

Answer

Diabetes Mellitus

Answer

Sickle cell anemia

Answer

Acute pyelonephritis

Question 4

Which of the following is NOT a feature of Potter syndrome?

Accepted Answer

Polyhydramnios

Answer

Bilateral renal agenesis

Answer

Pulmonary hypoplasia

Answer

Flattened facies

Question 5

Broad cast is a feature of which of the following conditions?

Accepted Answer

Chronic Renal failure

Answer

Acute Renal failure

Answer

Acute glomerulonephritis

Answer

Chronic glomerulonephritis

Question 6

What is an example of Pauci-immune Rapidly Progressive Glomerulonephritis (RPGN)?

Accepted Answer

Wegener granulomatosis (Granulomatosis with polyangiitis)

Answer

Goodpasture syndrome

Answer

Membranoproliferative Glomerulonephritis (MPGN)

Answer

Alport's syndrome

Question 7

Hypercoagulation in nephrotic syndrome is caused by?

Accepted Answer

Loss of antithrombin III

Answer

Decreased fibrinogen

Answer

Decreased metabolism of Vitamin K

Answer

Increase in protein C

Question 8

Electron microscopy is diagnostic in which of the following conditions?

Accepted Answer

Goodpasture's syndrome

Answer

Wegener's granulomatosis

Answer

Polyarteritis nodosa (PAN)

Answer

Anti-GBM disease

Question 9

Dense deposit disease is a characteristic finding in which of the following conditions?

Accepted Answer

Membranoproliferative Glomerulonephritis

Answer

Membranous Glomerulopathy

Answer

Mesangioproliferative Glomerulonephritis

Answer

No specific lesion

Question 10

Selective proteinuria is typically seen in which of the following conditions?

Accepted Answer

Nil lesion

Answer

Diabetic nephropathy

Answer

Focal segmental glomerulosclerosis

Answer

Mesangioproliferative glomerulonephritis

Renal Pathology — MCQs

Renal Pathology — MCQs

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