Renal Pathology Practice Questions

Q: Deletion of chromosome 11 leads to which of the following conditions?

Wilms tumor. **Explanation:** **Correct Option: A. Wilms tumor** Wilms tumor (Nephroblastoma) is the most common primary renal tumor of childhood [1]. Its pathogenesis is strongly linked to the **WT1 (Wilms Tumor 1) gene**, which is located on **chromosome 11p13** [1]. Deletions or mutations in this region lead to the development of the tumor. Furthermore, the **WT2 gene**, associated with Beckwith-Wiedemann syndrome, is located on **chromosome 11p15.5**. The loss of tumor suppressor genes on chromosome 11 is a classic driver for both sporadic and syndromic Wilms tumor (e.g., WAGR syndrome) [1]. **Incorrect Options:** * **B. Neuroblastoma:** This is associated with the amplification of the **N-MYC** proto-oncogene (chromosome 2p) and deletions of the short arm of **chromosome 1**. * **C. Retinoblastoma:** This is caused by a mutation or deletion of the **RB1 gene**, which is located on **chromosome 13q14**. * **D. Osteosarcoma:** While complex genetically, it is most famously associated with mutations in the **RB1 (13q14)** and **TP53 (17p13)** genes. **High-Yield Clinical Pearls for NEET-PG:** * **WAGR Syndrome:** Wilms tumor, Aniridia, Genitourinary anomalies, and mental Retardation (associated with 11p13 deletion) [1]. * **Denys-Drash Syndrome:** Wilms tumor, Gonadal dysgenesis, and early-onset nephropathy (WT1 mutation). * **Beckwith-Wiedemann Syndrome (BWS):** Characterized by macroglossia, organomegaly, and hemihypertrophy; linked to the WT2 locus on 11p15.5 (genomic imprinting). * **Histology:** Look for the "triphasic" pattern—blastemal, stromal, and epithelial cells. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 487-488.

Q: The NPHS1 gene codes for which of the following proteins?

Nephrin. **Explanation:** The correct answer is **Nephrin**. The **NPHS1 gene**, located on chromosome 19q13, encodes **Nephrin**, a key transmembrane glycoprotein belonging to the immunoglobulin superfamily. Nephrin is the primary structural component of the **slit diaphragm** between podocyte foot processes [1]. It acts as a molecular sieve, providing a physical and electrostatic barrier that prevents the filtration of plasma proteins into the urine [1]. **Analysis of Options:** * **Option A (Podocin):** This protein is encoded by the **NPHS2 gene**. Mutations in NPHS2 lead to autosomal recessive steroid-resistant nephrotic syndrome (SRNS), typically presenting in childhood. * **Option C (α-actinin 4):** This is an actin-binding protein encoded by the **ACTN4 gene**. Mutations are associated with autosomal dominant forms of Focal Segmental Glomerulosclerosis (FSGS). * **Option D (α-actinin 3):** This protein is primarily expressed in skeletal muscle (fast-twitch fibers) and is not a structural component of the glomerular filtration barrier. **Clinical Pearls for NEET-PG:** 1. **Congenital Nephrotic Syndrome of the Finnish Type:** Caused by mutations in the **NPHS1** gene [1]. It presents with massive proteinuria *in utero* or immediately after birth. 2. **Slit Diaphragm Complex:** Remember the "Big Three" proteins: **Nephrin (NPHS1)**, **Podocin (NPHS2)**, and **CD2AP** [1]. 3. **Morphology:** On electron microscopy, loss of NPHS1 results in the total absence of slit diaphragms and characteristic effacement of podocyte foot processes [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 905-907.

Question 1

Urine analysis of a patient with hematuria and glomerulonephrosis shows:

Accepted Answer

Isomorphic red cells

Answer

Red cell casts

Answer

WBC casts

Answer

Hyaline casts

Question 2

Which of the following is associated with Renal Papillary Necrosis?

Accepted Answer

Alcohol

Answer

Heroin

Answer

Morphine

Answer

Tramadol

Question 3

Which of the following is true about minimal change disease?

Accepted Answer

It is a common cause of nephrotic syndrome in children

Answer

Foot process effacement is seen on electron microscopy

Answer

IgA deposits are present on immunofluorescence

Answer

Serum complement levels are typically normal

Question 4

Mercury primarily affects which part of the kidney?

Accepted Answer

Proximal convoluted tubule (PCT)

Answer

Distal convoluted tubule (DCT)

Answer

Collecting duct

Answer

Loop of Henle

Question 5

A 58-year-old diabetic patient presents with hypertension and frothiness in the urine, with evidence of proteinuria. Renal biopsy demonstrated characteristic lesions of diabetic nephropathy. Which of the following is the most likely diagnosis?

Accepted Answer

Nodular glomerulosclerosis

Answer

Diffuse glomerulosclerosis

Answer

Basement membrane thickening

Answer

Crescentic glomerulonephritis

Question 6

Which of the following is associated with anti-glomerular basement membrane antibody?

Accepted Answer

Goodpasture's syndrome

Answer

IgA nephropathy

Answer

Membranous glomerulonephritis

Answer

Membranoproliferative glomerulonephritis

Question 7

Which of the following is NOT a histological feature of acute pyelonephritis?

Accepted Answer

Hypercellular glomerulus

Answer

Patchy interstitial suppurative inflammation

Answer

Intratubular aggregates of neutrophils

Answer

Tubular necrosis

Question 8

Deletion of chromosome 11 leads to which of the following conditions?

Accepted Answer

Wilms tumor

Answer

Neuroblastoma

Answer

Retinoblastoma

Answer

Osteosarcoma

Question 9

The NPHS1 gene codes for which of the following proteins?

Accepted Answer

Nephrin

Answer

Podocin

Answer

α - actinin 4

Answer

α - actinin 3

Question 10

In which of the primary glomerulonephritis are the glomeruli normal by light microscopy, showing loss of foot processes of the visceral epithelial cells and no deposits by electron microscopy?

Accepted Answer

Minimal change disease

Answer

Poststreptococcal glomerulonephritis

Answer

Membranoproliferative glomerulonephritis type I

Answer

IgA nephropathy

Renal Pathology — MCQs

Renal Pathology — MCQs

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