WorksheetsRenal Pathology
Total questions: 50
Worksheet time: 1hrs 11mins
A 25-year-old man presents with hematuria, periorbital edema, hypertension, and hemoptysis. He has also experienced nausea, vomiting, fever, and chills. Serologic testing is positive for antiglomerular basement membrane antibodies. Which of the following is the classic histologic finding in this renal disease?
Linear immunofluorescence
“Lumpy-bumpy” immunofluorescence
“Spike and dome” appearance of the glomerular basement membrane
Subendothelial immune complex deposition
Hematuria, azotemia, variable proteinuria, oliguria, edema, and hypertension
Chronic renal failure
Rapid progressive glomerulonephritis
Nephrotic syndrome
Nephritic syndrome
Primary glomerulopathy, except:
Minimal-change disease
Postinfectious
Wegener granulomatosis
Dense deposit disease
Which of the following is the EM finding in acute post streptococcal glomerulonephritis?
Mesagial deposits
Subepithelial humps
Intramembranous deposits
Subendothelial deposits
The most clinical manifestation IgA nephropathy is:
Proteinuria
Hematuria
Nephritic syndrome
Nephrotic syndrome
The morphologic lesion of rapidly progressing glomerulonephritis is:
Segmental sclerosis
Nodular sclerosis
Epithelial crescents
Wire loop lesions
Clinically mesangial lesions in the glomeruli are usually manifested as:
Proteinuria
Hematuria
Nephritic syndrome
Nephrotic syndrome
Patient sought consult for chest pain and hemoptysis associated with hematuria, and signs and symptoms of uremia. His blood pressure is elevated and he has grade III bipedal edema. As the clinician in charge, you suspect that he is suffering from an autoimmune disease in which antibodies against type IV collagen attack the basement membrane of the lungs and kidneys. On immunofluorescence renal biopsy would most probably reveal:
Granular IgG and C3 in GBM and mesangium
Linear IgG and C3
Focal IgM or C3
IgA in the mesangium
Proteinuria is usually manifested as?
Fruity urine
Tea colored urine
Ammoniacal urine
Bubbly urine
This pathology is characterized by distinctive combination of mesangial and endothelial proliferation, along
with thickening and duplication of the capillary basement membrane
Amyloidosis
Diabetic nephropathy
Membranoproliferative glomerulonephritis
Post-streptococcal glomerulonephritis
Crescentic glomerulonephritis is most associated with:
p-ANCA
HIV
Cytomegalovirus
Cryoglobulin
Nephritic factor
A child was brought to your clinic complaining of hematuria. He had sore throat 5 days prior to consult. What do you expect to find on electron microscopy?
discrete, amorphous, electron-dense deposits on the epithelial side of the membrane, often having the appearance of “humps"
uniform and diffuse effacement of foot processes
double contour” or “tram-track” appearance
presence of electron-dense deposits predominantly in the mesangium
Most important urinalysis finding in poststreptococcal glomerulonephritis
RBC in urine
Granular cast in urine
Waxy cast in urine
RBC cast in urine
Which of the following GN usually present as nephritic syndrome?
Minimal change disease
Focal segmental glomerulonephritis
Membranous glomerulopathy
Acute post streptococcal glomerulonephritis
A 20-year old female presented with malar rash, oral ulcers, protosensitivity and proteinuria with granules or casts, kidney biopsy was done showing a "wire loop abnormality" on light microscope with marked subendothelial immune complex deposition on electron microscope. What is the diagnosis?
IqA nephropathy
Goodpasture syndrome
Focal segmental glomerulosclerosis
Lupus nephropathy
What is the most common and the most severe form of LUPUS NEPHRITIS ?
Minimal mesanglial
Mesanglial proliferative
Focal proliferative
Diffuse proliferative
An 18-year old male noted recurrent painless hematuria after having bloody diarrhea and fever 2 weeks before. No other sign or symptom was noted. The most likely diagnosis is:
IgA Nephropathy
Minimal change disease
Membranoproliferative glomerulonephritis
Post-streptococcal glomerulonephritis
Autosomal recessive, enlarged cystic kidneys at birth, Hepatic fibrosis is a known complication:
Adult polycystic disease
Medullary sponge kidney
Simple cyst
Acquired renal cystic disease
Childhood polycystic kidney disease
True about simple cysts, except:
May be single or multiple and usually involve the cortex
Translucent scent, lined by a gray, glistening, smooth muscle, and filled with clear fluid
Main importance of cysts lies in their differentiation from kidney tumors
On microscopic examination, it is composed of multilayer flattened cuboidal epithelium
Result from renal fusion producing a U-shaped structure continous across the midline and anterior to the aorta and inferior vena cava
Bile cast nephropathy
Light chain deposition disease
Ectopic kidneys
Horshoe kidneys
A 13 year old female presented with headache and decreased urine output after a 4 week history of skin infection. Which of the following is the most likely morphology of the kidney?
linear GBM fluorescence for Ig and complement
discrete subendothelial electron dense deposits
granular deposits of IgG, IgM, and C3 in the mesangium and along the GBM
GBM transformed into an irregular ribbon like, electron dense structure
What is the mechanism of edema in nephrotic syndrome?
Glomerular injury
Increased capillary permeability to proteins
Decreased protein absorption
Tubulointerstitial disorder
The most likely renal pathology in multiple myeloma is:
Tubulo-interstitial nephritis
Membranoproliferative glomerulonephritis
Acute glomerulonephritis
Focal segmental glomerulosclerosis
Wire-loop capillaries are seen in which type of kidney disease?
Lupus nephritis
RPGN
Diabetic nephropathy
Polycystic kidney disease
What is the most common and the most severe type of Lupus nephropathy?
Type I
Type II
Type III
Type IV
Variant of Renal Cell Carcinoma which is made up of pale eosinophilic cells, often with a perinuclear halo, arranged in solid sheets with a concentration of the largest cells around blood vessels?
Clear cell CA
Papillary CA
Chromophobe CA
Collecting Duct CA
Which of the following is true regarding dense deposit disease?
Characterized by immune complex deposits in the glomerular basement membrance and activiation of classical pathway
Highly responsive to treatment with immunosuppresive drugs such as pulse cyclophosphamide combined with steroids
Diminished serum levels of factor B and properdin
Dense materials are primarily deposited on the podocyte-GBM junction
What is the most characteristic lesion of HIV associated nephropathy ?
Capillary wall hyalinosis
Duplication of the basement membrane
Retraction of the entire glomerulus
Diffuse mesangial proliferation
What major fibril protein responsible for secondary amyloidosis on a chronic kidney disease patient on prolonged hemodialysis ?
Amyloid light chain
Beta microglobulin
transthyretin
calcitonin
Foot process effacement associated with normal glomeruli by light microscopy makes this diagnosis:
membranous nephropathy
minimal change disease
PSGN
Berger disease
A 27-year-old female with hypertension was found to have renal artery stenosis. What is the expected morphologic finding on examination?
a concentrically placed atheromatous plaque with superimposed thrombosis
eosinophilic granular change in blood vessel wall staining (+) for fibrin
fibromuscular thickening involving the media of artery
intimal thickening caused by proliferation of elongated, concentrically arranged smooth muscle cells
A renal biopsy that shows hypercellular glomeruli on light microscopy, "starry sky" pattern of immunofluorescence and subepithelial immune complex humps on electron microscopy is most consistent with which of the following diagnosis?
Rapidly progressive glomerulonephritis
Acute poststreptococcal glomerulonephritis
IgA nephropathy
Membranoproliferative glomerulonephritis
A 49-year-old woman is admitted to the hospital because of renal failure. She has had episodes of flank pain over the past 20 years. She has also had nocturia 2 to 3 times nightly for 10 years. Her blood pressure is 160/100 mm Hg. Examination shows pale mucous membranes. A mass is palpated in the right flank. Which of the following is the
most likely diagnosis?
Horseshoe kidney
Nephrolithiasis
Papillary necrosis
Polycystic kidney disease
Renal cell carcinoma is MOST COMMONLY derived from cells of the:
Glomerulus
Proximal tubule
Loop of Henle
Distal tubule
Variant of renal cell carcinoma which is made up of polygonal cells with abundant clear cytoplasm
Chromophobe renal CA
Papillary CA
Medullar CA
Clear cell CA
Most common cause of Nephrotic Syndrome in adults:
Membranous nephropathy
Minimal-change disease
Focal-segmental glomerulosclerosis
Diabetes Mellitus
Most common cause of Nephrotic Syndrome in children:
Membranous nephropathy
Minimal-change disease
SLE
Lymphoma
Alport syndrome is a form of hereditary nephritis that i caused by mutations in genes encoding for what type of collagen?
Type I
Type II
Type III
Type IV
Azotemia, hypocalcemia and huperparathyroidism are associated with:
Acute renal failure
Chronic renal failure
Nephrotic syndrome
Nephriitic syndrome
Which is not associated with diabetic nephropathy?
Kimmelsteil-Wilson disease
Acute pyelonephritis
Papillary necrosis
Renal artery stenosis
IgA deposit in mesangium can be appreciated by:
Immunoflourescence microscopy
Electron microscopy
Light microscopy
All of the above
Nephritic factor dense deposits are related to?
Membranoproliferative glomerulonephritis
Lipoid nephrosis
Focal segmental glomerulonephritis
Acute post-streptococcal glomerulonephritis
Associated with Proteus infection, also called Staghorn calculi:
Calcium stiones
Uric acid stones
Struvite stones
None of these
A study of renal disease identifies patients with greater than 3.5g of protein in a 24-hour urine collection, but no RBCs or WBC's. Dysfunction involving which of the following cells most likely to be responsible for proteinuria?
Endothelium
Macula densa
Mesangium
Parietal epithelium
Podocytes
Which of the following tests is kost valuable in confirming Goodpasture's syndrome?
Diffuse linear staining of GBM with IgG
Granular lumpy bumpy deposits of IgG
Urine culture for resistant E.coli
Diffuse thickening of G on electron microscopy
Nephritic syndrome is associated with:
Lipoid nephrosis
Goodpasture's disease
Both
Neither
Renal cell carcinoma is associated with which characteristic(s)?
Invades renal vein
Clear cell type
Both
Neither
Acute post-streptococcal glomerulonephritis is characterized by:
Tubulorrhexis
Thick basement membrane
Both
Neither
Nephrotic syndrome is found in which disease?
Diabetes Mellitus
Membranous glomerulonephritis
Both
Neither
The most common cause of acute pyelonephritis is (are)
Entamoeba coli
Staphylococcus aureus
Both
Neither
