Renal Pathology Practice Questions

Q: Which of the following statements about renal cell carcinoma is FALSE?

Bellini duct carcinoma arises from the loop of Henle.. **Explanation:** Renal Cell Carcinoma (RCC) is a heterogeneous group of tumors arising from the renal tubular epithelium. Understanding the specific anatomical origin of each subtype is high-yield for NEET-PG. **Why Option D is the Correct (False) Statement:** Bellini duct carcinoma (also known as **Collecting Duct Carcinoma**) is a rare, highly aggressive subtype of RCC. It arises from the **collecting ducts** (specifically the principal cells) located in the renal medulla, **not the loop of Henle**. **Analysis of Other Options:** * **Option A:** Risk factors for RCC include smoking (most common), obesity, hypertension, and occupational exposure to **asbestos, cadmium, and petroleum products**. **Sickle cell trait/disease** is specifically associated with Renal Medullary Carcinoma. * **Option B:** **Clear cell RCC** (the most common subtype, 75-80%) and **Papillary RCC** both originate from the **Proximal Convoluted Tubule (PCT)**. In contrast, Chromophobe RCC arises from the intercalated cells of the collecting duct. * **Option C:** RCC is known for hematogenous spread. **"Cannonball metastases"** refer to well-circumscribed, large, round secondary deposits in the lungs, which are a classic radiological feature of metastatic RCC. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad:** Hematuria, flank pain, and palpable mass (seen in only 10% of cases; signifies advanced disease). * **Most common site of metastasis:** Lung. * **Stauffer Syndrome:** Reversible hepatic dysfunction (elevated LFTs) in the absence of liver metastases. * **Genetic Association:** Clear cell RCC is associated with the **VHL gene** deletion on **Chromosome 3p**. * **Treatment of Choice:** Radical nephrectomy (or partial nephrectomy for T1 tumors). RCC is notoriously resistant to chemotherapy and radiotherapy.

Q: What is the pathognomonic feature of Alport syndrome?

Lenticonus and hematuria. **Explanation:** Alport Syndrome is a hereditary nephritis caused by mutations in the genes encoding the **α-chains of Type IV collagen** (most commonly *COL4A5*), which is a crucial structural component of basement membranes in the kidney, eye, and cochlea [1]. **Why Option A is Correct:** While hematuria is the most common presenting symptom [1], **Anterior Lenticonus** (a cone-shaped protrusion of the lens surface into the anterior chamber) is considered the **pathognomonic** clinical feature. It occurs in approximately 15–25% of patients and is virtually diagnostic of Alport syndrome. The combination of persistent microscopic/gross hematuria and lenticonus strongly confirms the diagnosis. **Analysis of Incorrect Options:** * **Option B & C:** While **Sensorineural Hearing Loss (SNHL)** is a classic part of the Alport triad (alongside renal failure and ocular defects), it is not pathognomonic [1]. SNHL can be found in many other genetic syndromes and environmental conditions. * **Option D:** Hyperextensibility of joints is characteristic of connective tissue disorders like Ehlers-Danlos Syndrome, not Alport syndrome. **High-Yield Clinical Pearls for NEET-PG:** * **Inheritance:** Most common is **X-linked Dominant** (85%) [1]. * **Electron Microscopy (EM):** The classic finding is the **"Basket-weave appearance"** due to irregular thinning and thickening of the Glomerular Basement Membrane (GBM) with splitting of the lamina densa. * **The Triad:** 1. Progressive Hematuria/Renal failure, 2. Sensorineural deafness, 3. Ocular abnormalities (Lenticonus, maculopathy). * **Differential:** Thin Basement Membrane Lesion (Benign Familial Hematuria) shows only diffuse thinning of the GBM without the "basket-weave" pattern or extra-renal features [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 929-930.

Question 1

IgA deposition in mesangial cells is seen in which condition?

Accepted Answer

Berger disease

Answer

Goodpasture syndrome

Answer

Crescentic glomerulonephritis

Answer

Alport syndrome

Question 2

Proteinuria caused by tubule-interstitial renal disease is confirmed by the excretion of which of the following?

Accepted Answer

Light chain

Answer

Albumin

Answer

Immunoglobulin A

Answer

Tamm-Horsfall protein

Question 3

A four-year-old child develops steroid-sensitive nephrotic syndrome. Renal biopsy studies demonstrate normal-appearing glomeruli by light microscopy and fusion of foot processes by electron microscopy. Which of the following proteins would be present in the urine in the highest concentration?

Accepted Answer

Albumin

Answer

Ceruloplasmin

Answer

IgA

Answer

Kappa light chain

Question 4

Which type of renal cell carcinoma is associated with the worst prognosis?

Accepted Answer

Collecting duct RCC

Answer

Clear cell carcinoma

Answer

Chromophobe type RCC

Answer

Papillary RCC

Question 5

Which of the following statements about renal cell carcinoma is FALSE?

Accepted Answer

Bellini duct carcinoma arises from the loop of Henle.

Answer

Asbestos, sickle cell anemia, and petroleum products are risk factors.

Answer

Clear cell carcinoma arises from the proximal convoluted tubule.

Answer

Cannonball metastases are characteristic.

Question 6

All of the following statements regarding membranous nephropathy are true except?

Accepted Answer

Rupture of the glomerular basement membrane is a characteristic feature.

Answer

It is the most common cause of nephrotic syndrome in adults.

Answer

Antibodies to phospholipase A2 receptor are present.

Answer

A 'spike and dome' appearance is visualized on electron microscopy.

Question 7

Focal glomerulonephritis can be seen in all of the following conditions EXCEPT-

Accepted Answer

Hypertension

Answer

Wegener's granulomatosis

Answer

Infective endocarditis

Answer

IgA nephropathy

Question 8

Increased renin activity is seen in which of the following conditions?

Accepted Answer

Malignant nephrosclerosis

Answer

Benign nephrosclerosis

Answer

Hemolytic Uremic Syndrome (HUS)

Answer

Malignant hypertension (MHA)

Question 9

All of the following statements are true about post-streptococcal glomerulonephritis except?

Accepted Answer

All cases of streptococcal infection lead to glomerulonephritis.

Answer

Early treatment of streptococcal pharyngitis prevents glomerulonephritis.

Answer

Hump sign may be present.

Answer

Immune complex deposits are seen.

Question 10

What is the pathognomonic feature of Alport syndrome?

Accepted Answer

Lenticonus and hematuria

Answer

Hematuria and sensorineural hearing loss

Answer

Sensorineural hearing loss and lenticonus

Answer

Hematuria and hyperextensibility of joints

Renal Pathology — MCQs

Renal Pathology — MCQs

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