Renal pathology Practice Questions

Q: Kidney biopsy report shown in the image depicts:

Nodular glomerulosclerosis. ***Nodular glomerulosclerosis*** - The image likely depicts **Kimmelstiel-Wilson nodules**, which are characteristic of **diabetic nephropathy** and fall under the umbrella of nodular glomerulosclerosis [1]. - These nodules are **acellular, eosinophilic, PAS-positive** masses found in the mesangium [1]. *Focal segmental glomerulosclerosis* - Characterized by **sclerosis** affecting only some glomeruli (**focal**) and only parts of the affected glomeruli (**segmental**). - It typically presents with **effacement of foot processes** on electron microscopy and is a common cause of nephrotic syndrome. *Armanni Ebstein changes* - These are **glycogen-rich vacuolations** seen in the **tubular epithelial cells** of the kidney, particularly in the proximal tubules, in patients with **uncontrolled diabetes mellitus**. - They are a sign of **osmotic nephrosis** due to severe hyperglycemia, not a primary glomerular lesion. *Membranoproliferative glomerulonephritis* - Characterized by **mesangial and endothelial cell proliferation** and **thickening of the glomerular basement membrane** (GBM). - Often shows a **"tram-track" appearance** on light microscopy due to GBM splitting, which is not the primary feature depicted. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1121-1122.

Q: Comment on the diagnosis of light microscopy finding in kidney biopsy. (Recent NEET Pattern 2016-17)

Nodular glomerulosclerosis. ***Nodular glomerulosclerosis*** - This finding is characteristic of **diabetic nephropathy**, specifically the **Kimmelstiel-Wilson lesions** [1]. - It involves the formation of **nodular deposits** in the mesangium, leading to glomerulosclerosis. *Focal segmental glomerulosclerosis* - Characterized by **sclerosis** affecting only **some glomeruli** (focal) and only **parts of the glomerular tuft** (segmental). - It is a common cause of **nephrotic syndrome** and is often associated with HIV, heroin abuse, or genetic mutations. *Diffuse glomerulosclerosis* - Implies widespread sclerosis affecting **most or all glomeruli diffusely**. - This is a general term and can be seen in various end-stage renal diseases, not specific to a single primary diagnosis like nodular glomerulosclerosis. *Minimal change disease* - On light microscopy, the glomeruli appear **normal**, hence the term "minimal change" [2]. - The characteristic finding is **effacement of foot processes** on electron microscopy [2], and it is a common cause of nephrotic syndrome in children. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, p. 1121. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 922-923.

Q: All are causes of this glomerular presentation except: (Recent NEET Pattern 2016-17)

Reflux nephropathy. ***Reflux nephropathy*** - This condition primarily causes **tubulointerstitial damage** and **scarring**, leading to chronic kidney disease, but it is not a direct cause of a primary glomerular presentation like **focal segmental glomerulosclerosis (FSGS)**. - While it can lead to proteinuria, it's usually due to secondary glomerular changes from chronic damage rather than a primary glomerular disease. *HIV* - **HIV-associated nephropathy (HIVAN)** is a common cause of **collapsing FSGS**, a specific glomerular presentation [1] [2]. - It is characterized by rapid progression to end-stage renal disease and often presents with heavy proteinuria [1]. *Hepatitis B* - Hepatitis B infection is strongly associated with **membranous nephropathy** and, less commonly, with **membranoproliferative glomerulonephritis (MPGN)**, both of which are distinct glomerular presentations [1]. - These conditions involve immune complex deposition in the glomeruli. *Heroin abuse* - Heroin abuse is a well-known cause of **focal segmental glomerulosclerosis (FSGS)**, often presenting as **heroin-associated nephropathy** [3] [4]. - This condition typically leads to significant proteinuria and progressive renal failure [3] [4]. **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. 531-532. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 924-925. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 927-928. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 530-531.

Q: Comment on type of glomerulonephritis present in the kidney biopsy slide. (Recent NEET Pattern 2016-17)

Crescentic glomerulonephritis. ***Crescentic glomerulonephritis*** - The presence of **crescents** in the glomeruli is the hallmark of **crescentic glomerulonephritis**, indicating severe glomerular injury [1]. - Crescents are formed by the proliferation of **parietal epithelial cells** and infiltration of macrophages, leading to rapid decline in renal function [1]. *Acute glomerulonephritis* - This is a broad term that can encompass various forms of glomerulonephritis, but it does not specifically describe the **morphological finding of crescents**. - Acute glomerulonephritis often presents with **nephritic syndrome** (hematuria, proteinuria, hypertension), but the biopsy finding of crescents is more specific [1]. *Focal segmental glomerulosclerosis* - Characterized by **sclerosis** (scarring) affecting **some glomeruli** (focal) and **only parts of the glomerular tuft** (segmental). - It typically presents with **nephrotic syndrome** (heavy proteinuria, edema, hypoalbuminemia), which is distinct from the rapid renal failure seen with crescents. *Diffuse glomerulosclerosis* - This term implies widespread **sclerosis** affecting **all glomeruli**, often seen in advanced chronic kidney disease. - It does not specifically describe the **active inflammatory process** and crescent formation characteristic of crescentic glomerulonephritis [2]. **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. 528-529. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 536-537.

Q: The image shows:

A= Flea bitten kidney, B= Malignant Hypertension. ***A= Flea bitten kidney, B= Malignant Hypertension*** - The term **"flea-bitten kidney"** describes the gross appearance of the kidney in **malignant hypertension**, characterized by numerous pinpoint hemorrhages on the cortical surface [1]. - These hemorrhages are due to **rupture of arterioles and capillaries** caused by the severe elevation in blood pressure [1][2]. *A= Flea bitten kidney, B= Acute Glomerulonephritis* - While **acute glomerulonephritis** can cause kidney injury, the classic gross appearance is typically a **swollen, pale kidney**, not specifically "flea-bitten." - The "flea-bitten" appearance is a more specific descriptor for the vascular damage seen in **malignant hypertension** [1]. *A= Chronic shrunken kidney, B= Crescentic glomerulonephritis* - **Crescentic glomerulonephritis** is characterized by the formation of **crescents** in Bowman's capsule, leading to rapid progressive renal failure. - While it can lead to a **shrunken kidney** in its chronic stages, the acute presentation is not typically "flea-bitten," and the primary pathology is glomerular, not widespread vascular hemorrhage. *A= Chronic Shrunken kidney, B= Malignant hypertension* - Although **malignant hypertension** can lead to chronic kidney disease and a shrunken kidney over time, the **"flea-bitten"** appearance is an acute gross finding associated with the severe vascular damage [2]. - A **chronically shrunken kidney** is a general term for end-stage renal disease from various causes, and doesn't specifically describe the acute findings of malignant hypertension. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 276-277. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, p. 945.

Q: Kidney specimen of 40 -year-old man is shown below. All are true about the condition shown in the figure except:

Cysts are derived from collecting duct tubules. ***Cysts are derived from collecting duct tubules*** - This statement is incorrect because the cysts in **Autosomal Dominant Polycystic Kidney Disease (ADPKD)**, which is likely depicted in the image, are derived from **all segments of the nephron**, not exclusively collecting duct tubules [1]. - While collecting ducts can be involved, the characteristic feature is widespread cystic dilation of various nephron segments. *Cysts do not communicate with pelvis of the kidney* - This statement is true for ADPKD. The cysts in ADPKD are typically **closed sacs** and do not directly communicate with the renal pelvis or the collecting system. - This non-communication is a key feature distinguishing them from conditions like hydronephrosis. *PKD-2 gene is located on chromosome 4* - This statement is true. The **PKD2 gene**, which encodes for polycystin-2, is indeed located on **chromosome 4**. - Mutations in PKD2 account for a smaller percentage of ADPKD cases (about 15%) compared to PKD1. *Loss of corticomedullary differentiation* - This statement is true and is a common finding in advanced ADPKD. As the cysts enlarge and replace normal renal parenchyma, the distinct architectural separation between the **renal cortex and medulla** is lost. - This loss of differentiation is often visible on imaging studies like ultrasound or MRI. **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. 544-545.

Q: The image shows presence of:

Autosomal dominant polycystic kidney. ***Autosomal dominant polycystic kidney*** - This condition is characterized by the presence of numerous **cysts of varying sizes** in both kidneys, leading to significant kidney enlargement and eventual renal failure [1,2]. - The cysts originate from any segment of the **nephron** and progressively enlarge over time [1,2]. *Medullary sponge kidney* - This condition involves dilation of the **collecting ducts** in the renal pyramids, often appearing as small cysts or striations on imaging. - It typically presents with **recurrent kidney stones** and urinary tract infections, and the overall kidney architecture is usually preserved, unlike the diffuse cystic changes seen in the image. *Renal cystic dysplasia* - This is a developmental anomaly characterized by disorganized renal parenchymal development with primitive ducts and undifferentiated mesenchyme, often associated with **ureteral obstruction** during development. - It usually presents as a **unilateral** condition with a grossly abnormal kidney, which is different from the bilateral, numerous, and well-formed cysts seen in the image [2]. *Autosomal recessive polycystic kidney* - This condition typically presents in **infancy or childhood** with enlarged, smooth kidneys containing numerous small, uniform cysts that originate from the **collecting ducts** [1]. - It is often associated with **hepatic fibrosis** and portal hypertension, and the cysts are generally much smaller and more uniformly distributed than those seen in the image, which are characteristic of the adult-onset dominant form. **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. 544-545. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 950-952.

Q: A 28-year-old female with history of urinary tract infection presents with flank pain. On surgical extraction of the kidney, patient's presentation is similar to that given in the image. What is the likely diagnosis?

Struvite stone. ***Struvite stone*** - The history of **urinary tract infection (UTI)** and the likely appearance of a **staghorn calculus** (filling the renal pelvis and calyces) in the image strongly suggest a **struvite stone** [1][2]. - Struvite stones are also known as **infection stones** and are typically formed by **urease-producing bacteria** (e.g., *Proteus* species) that raise urine pH [1]. *Calcium oxalate stone* - These are the **most common type of kidney stone** [2] but are not typically associated with recurrent UTIs leading to large, branching calculi. - They are often **radiopaque** and can be associated with hypercalciuria or hyperoxaluria. *Uric acid stone* - Uric acid stones are typically associated with **acidic urine** and conditions like **gout** or myeloproliferative disorders. - They are **radiolucent** (not visible on plain X-ray) and do not usually form staghorn calculi. *Cystine stone* - Cystine stones are rare and result from an **inherited disorder** of amino acid transport, leading to high urinary cystine levels. - They can be **radiopaque** but are not primarily linked to recurrent UTIs or the formation of large staghorn calculi. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, p. 957. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 491-492.

Question 1

Kidney biopsy report shown in the image depicts:

Accepted Answer

Nodular glomerulosclerosis

Answer

Focal segmental glomerulosclerosis

Answer

Armanni Ebstein changes

Answer

Membranoproliferative glomerulonephritis

Answer

Diffuse glomerulosclerosis

Question 2

Comment on the diagnosis of light microscopy finding in kidney biopsy. (Recent NEET Pattern 2016-17)

Accepted Answer

Nodular glomerulosclerosis

Answer

Focal segmental glomerulosclerosis

Answer

Diffuse glomerulosclerosis

Answer

Minimal change disease

Answer

Membranoproliferative glomerulonephritis

Question 3

All are true about the presentation in kidney biopsy shown except: (Recent NEET Pattern 2016-17)

Accepted Answer

IgG and properdin deposits

Answer

Loss of foot processes

Answer

Hyalinosis

Answer

Seen with HIV associated nephropathy

Answer

Presents with nephrotic syndrome

Question 4

All are causes of this glomerular presentation except: (Recent NEET Pattern 2016-17)

Accepted Answer

Reflux nephropathy

Answer

HIV

Answer

Hepatitis B

Answer

Heroin abuse

Answer

Obesity

Question 5

Comment on type of glomerulonephritis present in the kidney biopsy slide. (Recent NEET Pattern 2016-17)

Accepted Answer

Crescentic glomerulonephritis

Answer

Acute glomerulonephritis

Answer

Focal segmental glomerulosclerosis

Answer

Diffuse glomerulosclerosis

Answer

Membranous glomerulonephritis

Question 6

The image shows:

Accepted Answer

A= Flea bitten kidney, B= Malignant Hypertension

Answer

A= Flea bitten kidney, B= Acute Glomerulonephritis

Answer

A= Chronic shrunken kidney, B= Crescentic glomerulonephritis

Answer

A= Chronic Shrunken kidney, B= Malignant hypertension

Answer

A= Acute tubular necrosis, B= Chronic glomerulonephritis

Question 7

Kidney specimen of 40 -year-old man is shown below. All are true about the condition shown in the figure except:

Accepted Answer

Cysts are derived from collecting duct tubules

Answer

Cysts do not communicate with pelvis of the kidney

Answer

PKD-2 gene is located on chromosome 4

Answer

Loss of corticomedullary differentiation

Answer

Associated with berry aneurysms in the circle of Willis

Question 8

The image shows presence of:

Accepted Answer

Autosomal dominant polycystic kidney

Answer

Medullary sponge kidney

Answer

Renal cystic dysplasia

Answer

Autosomal recessive polycystic kidney

Answer

Simple renal cysts

Question 9

The kidneys shown in this image are from a 24 -yearold man. What would have been the most likely cause of his death?

Accepted Answer

A subarachnoid hemorrhage due to ruptured berry aneurysm

Answer

Hypertension

Answer

Chronic renal failure

Answer

Metastatic renal cell carcinoma

Answer

Myocardial infarction

Question 10

A 28-year-old female with history of urinary tract infection presents with flank pain. On surgical extraction of the kidney, patient's presentation is similar to that given in the image. What is the likely diagnosis?

Accepted Answer

Struvite stone

Answer

Uric acid stone

Answer

Cystine stone

Answer

Calcium oxalate stone

Answer

Calcium phosphate stone

Renal pathology — MCQs

Renal pathology — MCQs

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