Renal pathology Practice Questions

Question 1

A 22-year-old man comes to the physician because of a 2-week history of cough and decreased urination. The cough was initially nonproductive, but in the last few days he has coughed up small amounts of blood-tinged sputum with clots. He has not had any fevers, chills, or weight loss. He has smoked one pack of cigarettes daily for 5 years. Pulse is 115/min and blood pressure is 125/66 mm Hg. Physical examination shows dried blood around the lips. Serum studies show a creatinine of 2.9 mg/dL. Results of a serum antineutrophil cytoplasm antibody test are negative. A biopsy specimen of the kidney is most likely to show which of the following light microscopy findings?

Accepted Answer

Fibrin crescents in Bowman space

Answer

Thinning of the basement membrane

Answer

Expansion of the mesangial matrix

Answer

Enlarged and hypercellular glomeruli

Answer

Neutrophilic infiltration of the capillaries

Question 2

On cardiology service rounds, your team sees a patient admitted with an acute congestive heart failure exacerbation. In congestive heart failure, decreased cardiac function leads to decreased renal perfusion, which eventually leads to excess volume retention. To test your knowledge of physiology, your attending asks you which segment of the nephron is responsible for the majority of water absorption. Which of the following is a correct pairing of the segment of the nephron that reabsorbs the majority of all filtered water with the means by which that segment absorbs water?

Accepted Answer

Proximal convoluted tubule via passive diffusion following ion reabsorption

Answer

Distal convoluted tubule via passive diffusion following ion reabsorption

Answer

Distal convoluted tubule via aquaporin channels

Answer

Thick ascending loop of Henle via passive diffusion following ion reabsorption

Answer

Collecting duct via aquaporin channels

Question 3

A 42-year-old man presents to his primary care provider complaining of foamy urine for the last 2 weeks. He has also begun to notice swelling in his hands and feet, and he says that his shoes have not been fitting normally. On exam, the patient has a temperature of 98.8°F (37.1°C), blood pressure is 132/84 mmHg, pulse is 64/min, and respirations are 12/min. The patient has 2+ pitting edema bilaterally up to his shins. A 24-hour urine study is found to contain 9.0 g of protein. The patient is referred to a specialist and undergoes a renal biopsy. On light microscopy, the glomeruli demonstrate basement membrane thickening. On electron microscopy, subepithelial deposits are seen. Which of the following is a characteristic of this patient’s disease?

Accepted Answer

Antibodies to phospholipase A2 receptor

Answer

X-linked condition

Answer

Antibodies to alveolar basement membrane

Answer

Loss of podocyte foot processes

Answer

IgA immune complex deposition

Question 4

A 53-year-old woman presents to her physician for evaluation of sudden onset respiratory distress for the past few hours. The past medical history includes a myocardial infarction 2 years ago. The vital signs include a blood pressure 70/40 mm Hg, pulse 92/min, respiratory rate 28/min, and SpO2 92% on room air. The physical examination reveals bilateral basal crepitations on auscultation. The echocardiogram reveals an ejection fraction of 34%. She is admitted to the medical floor and started on furosemide. The urine output in 24 hours is 400 mL. The blood urea nitrogen is 45 mg/dL and the serum creatinine is 1.85 mg/dL. The fractional excretion of sodium is 2.4%. Urinalysis revealed muddy brown granular casts. Which of the following is the most likely cause of the abnormal urinalysis?

Accepted Answer

Acute tubular necrosis

Answer

Acute interstitial nephritis

Answer

Acute pyelonephritis

Answer

Chronic kidney disease

Answer

Acute glomerulonephritis

Question 5

A 6-year-old boy is brought to the physician because of increasing swelling around his eyes for the past 3 days. During this period, he has had frothy light yellow urine. He had a sore throat 12 days ago. He appears tired. His temperature is 37°C (98.6°F), pulse is 90/min, and blood pressure is 105/65 mm Hg. Examination shows periorbital edema and pitting edema of the lower extremities. Cardiopulmonary examination shows no abnormalities. Which of the following findings on urinalysis is most likely associated with this patient's condition?

Accepted Answer

Fatty casts

Answer

WBC casts

Answer

Hyaline casts

Answer

RBC casts

Answer

Muddy brown casts

Question 6

A 22-year-old man comes to the emergency department because of several episodes of blood in his urine and decreased urine output for 5 days. His blood pressure is 158/94 mm Hg. Examination shows bilateral lower extremity edema. Urinalysis shows 3+ protein and red blood cell casts. Mass spectrometry analysis of the urinary protein detects albumin, transferrin, and IgG. Which of the following best describes this type of proteinuria?

Accepted Answer

Nonselective glomerular

Answer

Tubular

Answer

Selective glomerular

Answer

Postrenal

Answer

Overflow

Question 7

A 26-year-old woman presents with blood in her urine for the past 2 days. She says she has had increasing urinary frequency at night for the past several days and recently noticed a reddish tinge in her urine. She is also concerned that her feet are beginning to swell, and she has been feeling increasingly fatigued for the past week. She gives no history of joint pains, rashes, or skin changes. Past medical history is relevant for an occasional bluish discoloration of her fingers during exposure to cold. Her vital signs are a pulse of 80/min, a respiratory rate of 14/min, and blood pressure of 140/88 mm Hg. On physical examination, the patient has 1+ pitting edema of her feet bilaterally. Remainder of examination is unremarkable. Laboratory findings are significant for the following:
Serum glucose (fasting) 88 mg/dL
Sodium 143 mEq/L
Potassium 3.7 mEq/L
Chloride 102 mEq/L
Serum creatinine 1.7 mg/dL
Blood urea nitrogen 32 mg/dL
Cholesterol, total 180 mg/dL
HDL-cholesterol 43 mg/dL
LDL-cholesterol 75 mg/dL
Triglycerides 135 mg/dL
Hemoglobin (Hb%) 12.5 g/dL
Mean corpuscular volume (MCV) 80 fL
Reticulocyte count 1%
Erythrocyte count 5.1 million/mm3
Thyroid stimulating hormone 4.5 μU/mL
Urinalysis:
Glucose negative
Protein +++
Ketones negative
Nitrites negative
RBCs negative
Casts +++
A renal biopsy is performed which reveals findings consistent with lupus nephritis. Which of the following is the next best step in treatment of this patient?

Accepted Answer

Mycophenolic acid

Answer

Cyclophosphamide

Answer

Corticosteroids

Answer

Cyclosporine

Answer

Azathioprine

Question 8

A 4-year-old girl is brought to the physician because of increasing swelling around her eyes and over both her feet for the past 4 days. During this period, she has had frothy light yellow urine. Her vital signs are within normal limits. Physical examination shows periorbital edema and 2+ pitting edema of the lower legs and ankles. A urinalysis of this patient is most likely to show which of the following findings?

Accepted Answer

Fatty casts

Answer

Epithelial casts

Answer

WBC casts

Answer

Waxy casts

Answer

Muddy brown casts

Question 9

A 72-year-old woman with a medical history significant for chronic kidney disease stage 4, hypertension, and type 2 diabetes mellitus, presents to the office for a scheduled visit. During her last visit, the physician started discussing with her the possibility of starting her on dialysis for her chronic kidney disease. The patient has no complaints about her health and enjoys spending time with her family. At presentation, she is afebrile; the blood pressure is 139/89 mm Hg and the heart rate is 80/min. On physical examination, her pulses are bounding, the complexion is pale, she has a grade ⅙ holosystolic murmur, breath sounds remain clear, and 2+ pedal edema to the knee. The measurement of which of the following laboratory values is most appropriate to screen for renal osteodystrophy in this patient?

Accepted Answer

Serum intact parathyroid hormone level

Answer

Erythrocyte sedimentation rate

Answer

Serum vitamin B-12 level

Answer

Serum C-reactive protein level

Answer

Serum thyroid-stimulating hormone level

Question 10

A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?

Accepted Answer

"Can you tell me more about the symptoms you have been experiencing?"

Answer

"Does the diarrhea typically precede the constipation, or vice-versa?"

Answer

"Is the diarrhea foul-smelling?"

Answer

"Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"

Answer

"Are the symptoms worse in the morning or at night?"

Renal pathology

Study Resources

Lessons

Questions

Flashcards

Lessons

Congenital renal anomalies

Glomerular diseases overview

Nephritic syndrome disorders

Nephrotic syndrome disorders

Rapidly progressive glomerulonephritis

Tubulointerstitial diseases

Acute tubular necrosis

Renal vascular diseases

Pyelonephritis and urinary tract infections

Renal cystic diseases

Obstructive uropathies

Renal tumors

Kidney transplant pathology

Practice Questions

Flashcards

About Renal pathology for USMLE

Lessons in Renal pathology

Master Renal pathology