Renal Pathology Practice Questions

Q: Which genetic alteration is associated with the chromophobe variant of renal cell carcinoma?

Monosomy of chromosomes 1 and Y (-1, -Y). ### Explanation **Chromophobe Renal Cell Carcinoma (RCC)** is a distinct subtype of renal cancer derived from the intercalated cells of the collecting ducts [1]. Its genetic profile is characterized by **extreme hypodiploidy** rather than specific gene mutations [1]. #### 1. Why Option D is Correct The hallmark of Chromophobe RCC is the **loss of entire chromosomes (monosomy)** [1]. The most frequent losses involve chromosomes **1, 2, 6, 10, 13, 17, 21, and Y**. Among these, the loss of chromosome 1 and the Y chromosome (in males) are classic diagnostic markers. This widespread chromosomal loss helps differentiate it from other RCC subtypes. #### 2. Why Other Options are Incorrect * **Options A & C (VHL gene / 3p deletions):** These are the genetic signatures of **Clear Cell RCC** (the most common subtype). The *VHL* gene is located on the short arm of chromosome 3 (3p25). * **Option B (Trisomy 7 and 17):** These are characteristic of **Papillary RCC**. Unlike Chromophobe RCC (which loses chromosomes), Papillary RCC is defined by the *gain* of chromosomes (trisomies/polysomies). #### 3. NEET-PG High-Yield Pearls * **Morphology:** Look for "plant-like" cells with prominent cell membranes, perinuclear halos, and "raisinoid" (wrinkled) nuclei [1]. * **Staining:** Chromophobe RCC shows diffuse cytoplasmic positivity with **Hale’s Colloidal Iron stain** (unlike other subtypes). * **Prognosis:** It generally carries a better prognosis compared to Clear Cell RCC [1]. * **Birt-Hogg-Dubé Syndrome:** This hereditary condition is specifically associated with an increased risk of Chromophobe RCC and oncocytomas. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, p. 959.

Q: Lipid casts are seen in which of the following conditions?

Nephrotic syndrome. **Explanation:** **Lipid casts** (and oval fat bodies) are a hallmark finding in **Nephrotic Syndrome** [1]. The underlying mechanism involves massive proteinuria, which triggers the liver to increase lipoprotein synthesis (hyperlipidemia). These lipids leak through the damaged glomerular basement membrane (lipiduria). When renal tubular epithelial cells (RTECs) endocytose these filtered lipids, they become "oval fat bodies." When these cells or free lipids are trapped within a matrix of Tamm-Horsfall protein in the distal tubules, they form lipid casts [2]. Under polarized microscopy, these show a characteristic **"Maltese Cross" appearance** due to the presence of cholesterol esters [2]. **Analysis of Incorrect Options:** * **Acute Tubular Necrosis (ATN):** Characterized by **"Muddy brown" granular casts** or epithelial cell casts resulting from the sloughing of necrotic tubular cells. * **Cytomegalic Inclusion Disease:** Typically shows characteristic large intranuclear inclusions (**"Owl’s eye" appearance**) within tubular cells, which may be seen in urine sediment as exfoliated cells, but not as lipid casts. **High-Yield Clinical Pearls for NEET-PG:** * **Hyaline casts:** Seen in dehydration or normal exercise (non-specific). * **Red Blood Cell (RBC) casts:** Pathognomonic for **Glomerulonephritis** (Nephritic syndrome). * **White Blood Cell (WBC) casts:** Indicative of **Pyelonephritis** or Tubulointerstitial nephritis. * **Waxy/Broad casts:** Suggestive of **Chronic Renal Failure** (due to stasis in dilated, atrophic tubules). * **Fatty casts + Maltese Cross = Nephrotic Syndrome.** **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 527-528. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 531-532.

Question 1

Which genetic alteration is associated with the chromophobe variant of renal cell carcinoma?

Accepted Answer

Monosomy of chromosomes 1 and Y (-1, -Y)

Answer

VHL gene mutations

Answer

Trisomy of chromosomes 7 and 17 (+7, +17)

Answer

3p deletions (3p-)

Question 2

Lipid casts are seen in which of the following conditions?

Accepted Answer

Nephrotic syndrome

Answer

Acute tubular necrosis

Answer

Cytomegalic inclusion disease

Answer

None of the above

Question 3

Pulmonary hypoplasia with urinary problems is associated with which of the following conditions?

Accepted Answer

Potter syndrome

Answer

Mobius syndrome

Answer

Patau syndrome

Answer

WAGR syndrome

Question 4

In Wilms tumor, which of the following leads to emergence of resistance to chemotherapy?

Accepted Answer

Anaplasia

Answer

Nephrogenic rests

Answer

Monoblastic morphology

Answer

Capsular infiltration

Question 5

Which of the following genes is associated with the Xp11 translocation variant of renal cell carcinoma?

Accepted Answer

TFE3

Answer

VHL

Answer

MET

Answer

TSC1

Question 6

Persistent low C3 complement level is not found in which of the following conditions?

Accepted Answer

Post-streptococcal glomerulonephritis

Answer

Mesangiocapillary glomerulonephritis

Answer

Cryoglobulinemia

Answer

Systemic lupus erythematosus

Question 7

Sub-epithelial humps are characteristic of which of the following conditions?

Accepted Answer

Post-streptococcal glomerulonephritis

Answer

Minimal change glomerulonephritis

Answer

Membranous glomerulonephritis

Answer

Membranoproliferative glomerulonephritis

Question 8

A 17-year-old primigravida complained of decreased fetal movements. She delivered a baby weighing 2000gms at 30 weeks of gestation. The Apgar scores of the baby were 4 and 5 at 1 and 5 minutes respectively. The baby died within an hour. A post-mortem examination revealed multiple, peripheral, radially arranged cysts in the kidney. What is the most common associated finding with this condition?

Accepted Answer

Congenital hepatic fibrosis

Answer

Holoprosencephaly

Answer

Ureteral agenesis

Answer

Medullary sponge kidney

Question 9

Bilaterally symmetrical contracted scarred kidneys are seen in which condition?

Accepted Answer

Chronic glomerulonephritis

Answer

Nephrosclerosis

Answer

End-stage renal disease

Answer

Chronic pyelonephritis

Question 10

In renal disease, why does albumin appear first in the urine?

Accepted Answer

Broad cast

Answer

Hyaline cast

Answer

Coarse granular cast

Answer

Epithelial cast

Renal Pathology — MCQs

Renal Pathology — MCQs

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