Renal Pathology Practice Questions

Q: The gross specimen section of kidney depicts which of the following?

Polycystic kidney. ***Polycystic kidney*** - Shows **multiple cysts** of varying sizes throughout the renal parenchyma, causing significant **kidney enlargement**. - The cysts replace normal kidney tissue and give the characteristic **"bunch of grapes"** appearance on gross examination. *Renal cell carcinoma* - Presents as a **solid mass** with areas of **necrosis** and **hemorrhage**, not multiple cysts. - Typically shows a **golden-yellow color** with variegated appearance due to lipid content. *Medullary cystic kidney* - Features **small cysts** confined to the **corticomedullary junction**, with overall **kidney shrinkage**. - Results in **small, scarred kidneys** rather than the enlarged cystic appearance seen here. *Hydatid cyst* - Appears as a **single, large cyst** with **thick walls** and **daughter cysts** inside. - Caused by **Echinococcus granulosus** infection and typically involves the **liver** more commonly than kidneys.

Q: A 75-year-old female patient presented with microscopic hematuria with RBC casts seen in the urine. Her serum creatinine was 3.9 mg/dl. Light microscopy and silver staining of the kidney specimen revealed specific findings. Which of the following would be the most appropriate diagnosis and the site of Ig deposits?

Membranous glomerulonephritis (GN), subepithelial deposits. ***Membranous glomerulonephritis (GN), subepithelial deposits*** - The **silver staining** reveals the classic **"spike and dome" pattern** characteristic of membranous GN, where basement membrane spikes project between subepithelial deposits. - **Subepithelial immune deposits** are pathognomonic for membranous GN, causing **basement membrane thickening** and nephrotic syndrome progression. *Post-streptococcal glomerulonephritis (PSGN), subepithelial deposits* - PSGN typically occurs in **children** following streptococcal infection, not in elderly patients like this case. - Silver staining shows **diffuse endocapillary proliferation** without the characteristic spike and dome pattern of membranous GN. *Type 1 Membranoproliferative glomerulonephritis (MPGN), subendothelial deposits* - MPGN Type 1 shows **"tram-track" appearance** on silver stain due to basement membrane splitting, not spike and dome pattern. - Deposits are **subendothelial and mesangial**, creating a double-contour effect rather than subepithelial spikes. *IgA nephropathy, mesangial deposits* - IgA nephropathy primarily affects **mesangial areas** with **mesangial proliferation** and sclerosis on silver stain. - **Mesangial deposits** do not produce the subepithelial spike and dome pattern seen in this case.

Q: What is the most common type of urinary stone associated with urinary tract infections?

Phosphate. The correct answer is **Phosphate (Option A)**, specifically in the form of **Struvite stones** (Magnesium Ammonium Phosphate). These are classically known as "infection stones." **Why Phosphate is correct:** Urinary tract infections (UTIs) caused by **urease-producing bacteria** (most commonly *Proteus mirabilis*, but also *Klebsiella* and *Staphylococcus saprophyticus*) lead to the hydrolysis of urea into ammonia. This process increases the urinary pH (alkalinization). In an alkaline environment, the solubility of phosphate decreases, leading to the precipitation of magnesium ammonium phosphate and carbonate apatite crystals. These stones can grow rapidly and often form large **Staghorn calculi** that fill the renal pelvis and calyces. **Why the other options are incorrect:** * **B. Urate (Uric Acid):** These stones form in **acidic urine** (low pH). They are associated with gout, high purine intake, or rapid cell turnover (e.g., leukemia). They are typically radiolucent. * **C. Cysteine:** These are rare genetic stones caused by a defect in the transport of dibasic amino acids (COAL: Cysteine, Ornithine, Arginine, Lysine). They form in acidic urine and have a characteristic "hexagonal" shape. * **D. Calcium Oxalate:** This is the **most common type of kidney stone overall**, but it is primarily associated with metabolic factors (hypercalciuria, hyperoxaluria) and dehydration, rather than infection. **High-Yield Clinical Pearls for NEET-PG:** * **Morphology:** Struvite stones show a characteristic **"Coffin-lid"** appearance under microscopy. * **Radiology:** Struvite and Calcium stones are **Radio-opaque**, whereas Uric acid stones are **Radiolucent**. * **Staghorn Calculus:** While most staghorn stones are Struvite, they can occasionally be composed of Cystine or Calcium oxalate. * **Management:** Treatment requires complete surgical removal of the stone and eradication of the underlying infection to prevent recurrence [1].

Question 1

What are the histological features of acute rejection of a renal transplant?

Accepted Answer

Neutrophilic infiltration

Answer

Areolar hyalinosis

Answer

Eosinophilic infiltration

Answer

Glomerular vasodilation

Question 2

Which of the following conditions is characterized by highly selective proteinuria?

Accepted Answer

Minimal change disease

Answer

Mesangial proliferative nephritis

Answer

Membranous glomerulonephritis

Answer

Focal glomerulosclerosis

Question 3

Immune complex-mediated glomerular damage is seen in all except?

Accepted Answer

Goodpasture's syndrome

Answer

Membranoproliferative GN

Answer

Crescentric GN

Answer

Focal segmental GN

Question 4

The gross specimen section of kidney depicts which of the following?

Accepted Answer

Polycystic kidney

Answer

Renal cell carcinoma

Answer

Medullary cystic kidney

Answer

Hydatid cyst

Question 5

Complement level is reduced in which of the following conditions?

Accepted Answer

Membranoproliferative glomerulonephritis

Answer

Minimal change disease

Answer

Membranous nephropathy

Answer

Focal and segmental glomerulosclerosis

Question 6

A 75-year-old female patient presented with microscopic hematuria with RBC casts seen in the urine. Her serum creatinine was 3.9 mg/dl. Light microscopy and silver staining of the kidney specimen revealed specific findings. Which of the following would be the most appropriate diagnosis and the site of Ig deposits?

Accepted Answer

Membranous glomerulonephritis (GN), subepithelial deposits

Answer

Post-streptococcal glomerulonephritis (PSGN), subepithelial deposits

Answer

Type 1 Membranoproliferative glomerulonephritis (MPGN), subendothelial deposits

Answer

IgA nephropathy, mesangial deposits

Question 7

What is the commonest cause of renal papillary necrosis?

Accepted Answer

Diabetes mellitus

Answer

Analgesic nephropathy

Answer

Pyelonephritis

Answer

Sickle cell anemia

Question 8

What is the most common cause of glomerulonephritis?

Accepted Answer

Berger disease

Answer

Acute glomerulonephritis

Answer

Chronic glomerulonephritis

Answer

Focal segmental glomerulosclerosis

Question 9

What is the most common type of urinary stone associated with urinary tract infections?

Accepted Answer

Phosphate

Answer

Urate

Answer

Cysteine

Answer

Calcium oxalate

Question 10

A child presents with hematuria following a respiratory tract infection. The child has a similar history approximately 5-10 months prior. All of the following statements are true regarding this condition, except?

Accepted Answer

Biopsy shows focal and diffuse proliferative changes in 50% of patients

Answer

C3 complement level is normal

Answer

Progressive renal failure occurs with each attack

Answer

Anti-streptococcal antibody titre may not rise after each attack

Renal Pathology — MCQs

Renal Pathology — MCQs

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