Renal Pathology Practice Questions

Q: What is the most common type of renal lesion in children?

Lipoid nephrosis. **Explanation:** The correct answer is **Lipoid nephrosis**, also known as **Minimal Change Disease (MCD)**. **Why Lipoid Nephrosis is Correct:** In the pediatric population, Nephrotic Syndrome is significantly more common than Nephritic Syndrome. Among the causes of Nephrotic Syndrome in children, Minimal Change Disease (Lipoid Nephrosis) accounts for approximately **75–80% of cases**, making it the most common renal lesion overall in this age group. The term "lipoid nephrosis" refers to the fatty changes seen in the tubule cells due to lipid resorption, though the hallmark of the disease is the effacement of podocyte foot processes visible only under electron microscopy. **Analysis of Incorrect Options:** * **B. Membranoproliferative glomerulonephritis (MPGN):** This is a less common cause of nephrotic/nephritic syndrome in children and is more frequently associated with chronic systemic infections or autoimmune diseases. * **C. Focal glomerulonephritis:** While Focal Segmental Glomerulosclerosis (FSGS) is the second most common cause of nephrotic syndrome in children, "focal glomerulonephritis" is a broader, less specific term and does not match the prevalence of MCD. * **D. Diffuse glomerulosclerosis:** This is typically a late-stage manifestation of chronic kidney disease or diabetic nephropathy, which is rare in the pediatric age group. **High-Yield Clinical Pearls for NEET-PG:** * **Age Group:** Most common between 2–6 years of age. * **Clinical Feature:** Presents with massive proteinuria, hypoalbuminemia, and generalized edema (anasarca). * **Treatment:** It is highly **steroid-responsive** (90% of children respond to Prednisolone). * **Microscopy:** Light microscopy appears **normal** (hence "minimal change"); Electron microscopy shows **effacement/fusion of foot processes**. * **Prognosis:** Generally excellent, though relapses are common.

Q: Which of the following is NOT a feature of Minimal Change Disease?

NSAIDs are a primary cause. **Explanation:** Minimal Change Disease (MCD) is the most common cause of nephrotic syndrome in children [1]. Understanding its pathogenesis and clinical features is crucial for NEET-PG. **Why Option D is the correct answer:** While NSAIDs are indeed associated with MCD, they are considered a **secondary cause**, not a primary (idiopathic) cause. Primary MCD is typically idiopathic, often linked to T-cell dysfunction and the release of glomerular permeability factors. Secondary causes include drugs (NSAIDs, Lithium), malignancies (Hodgkin Lymphoma), and allergies. **Analysis of other options:** * **Option A (Good response to steroids):** This is a hallmark of MCD. Over 90% of children show a dramatic response to corticosteroid therapy [1], which is a key diagnostic and therapeutic feature. * **Option B (Morphology):** MCD is characterized by a "minimal" change. Under **Light Microscopy**, the glomeruli appear completely **normal**. However, **Electron Microscopy** reveals the diagnostic feature: **diffuse effacement (fusion) of podocyte foot processes** [1]. * **Option C (Nil deposit disease):** This is an alternative name for MCD because **Immunofluorescence (IF)** shows no significant deposits of immunoglobulins or complement (Negative/Nil deposits) [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Most common presentation:** Sudden onset of heavy proteinuria (selective proteinuria, mainly albumin) [1]. * **Pathogenesis:** Loss of the glomerular polyanionic charge (heparan sulfate), leading to albumin leakage. * **Lipiduria:** "Maltese cross" appearance under polarized light due to cholesterol esters in urine. * **Prognosis:** Excellent in children; however, adults may take longer to respond to steroids and have a higher rate of relapse [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 922-928.

Question 1

Crescentic glomerulonephritis with pauci-immune glomerulonephritis is associated with which of the following?

Accepted Answer

Granulomatosis with polyangiitis

Answer

Post-infectious glomerulonephritis

Answer

Goodpasture's syndrome

Answer

Membranous glomerulonephritis

Question 2

Haematuria is seen in all except:

Accepted Answer

Focal segmental glomerulosclerosis (FSGS)

Answer

IgA nephropathy

Answer

Alport syndrome

Answer

Thin basement membrane disease

Question 3

Autosomal recessive kidney disease is caused due to mutation in which of the following genes?

Accepted Answer

Fibrocystin

Answer

Polycystin-1

Answer

Polycystin-2

Answer

None of the above

Question 4

Electron dense deposits in the region of hyalinosis and sclerosis with diffuse loss of foot processes seen in electron microscopy are features of which condition?

Accepted Answer

Focal segmental glomerulosclerosis

Answer

Minimal change disease

Answer

Membranous glomerulonephritis

Answer

Membranoproliferative GN

Question 5

A 7-year-old boy presents with bilateral swelling around his eyes. His parents state that the child's eyes have become "puffy" over the past several weeks, and his urine has become cocoa-colored. Physical examination reveals bilateral periorbital edema, but peripheral edema is not found. The boy is afebrile and his blood pressure is slightly elevated. A urinary dipstick reveals mild proteinuria, while microscopic examination of the boy's urine reveals hematuria with red blood cell casts. Laboratory tests reveal increased ASO titers and decreased serum C3 levels, but C2 and C4 levels are normal. A throat swab for streptococci is negative. A microscopic section from the kidney reveals increased numbers of cells within the glomeruli. An electron microscopic section of the kidney reveals large electron-dense deposits in the glomeruli that are located between the basement membrane and the podocytes. The foot processes of the podocytes are otherwise unremarkable. Which one of the following renal diseases most likely produced the abnormalities in this young boy?

Accepted Answer

Acute post-streptococcal glomerulonephritis

Answer

Focal segmental glomerulonephritis

Answer

Membranous glomerulonephritis

Answer

Minimal change disease

Question 6

What is the most common type of renal lesion in children?

Accepted Answer

Lipoid nephrosis

Answer

Membranoproliferative glomerulonephritis

Answer

Focal glomerulonephritis

Answer

Diffuse glomerulosclerosis

Question 7

Which characteristic feature is seen in the kidney in malignant hypertension?

Accepted Answer

Fibrinoid necrosis

Answer

Hyaline necrosis

Answer

Medial wall hyperplasia

Answer

Micro-aneurysm

Question 8

Visceral leishmaniasis is known to cause which type of glomerulonephritis?

Accepted Answer

Mesangioproliferative glomerulonephritis

Answer

Membranous glomerulonephritis

Answer

Focal segmental glomerulonephritis

Answer

Rapidly progressive glomerulonephritis

Question 9

Which disease is caused by anti-phospholipase A2 receptor antibody?

Accepted Answer

Membranous glomerulonephritis (MGN)

Answer

Membranoproliferative glomerulonephritis (MPGN)

Answer

Focal segmental glomerulosclerosis (FSGS)

Answer

Minimal change disease (MCD)

Question 10

Which of the following is NOT a feature of Minimal Change Disease?

Accepted Answer

NSAIDs are a primary cause

Answer

Good response to steroids

Answer

Effacement of podocytes on electron microscope, normal on light microscope

Answer

Nil deposit disease

Renal Pathology — MCQs

Renal Pathology — MCQs

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