RENAL PATHOLOGY - UNIT EXAM Tot al point s 82/109

T his is a Mult iple Choice Exam. Choose t he BEST answer from t he choices provided.

T he respondent 's email (ccuerpo@mham.edu.ph) was recorded on submission of t his

form.

A patient with acute glomerulonephritis was admitted for 0/1

complications associated with his disease. The doctors would want to
determine the current status of his kidney so that a CT-scan-guided
punch biopsy was performed. The tissue sections showed enlarged
glomeruli with evident hypercellularity. The bowman’s space was either
severely narrowed or obliterated by proliferating epithelial cells. WHICH
OF THE FOLLOWING IMMUNOFLUORESCENT FINDINGS IS NOT TYPICAL
OF THIS DISEASE CONDITION? *

Diffuse swelling of foot processes

Immunoglobulins & complement present

Lit t le or no deposit ion of immune react ant s

Granular immune deposit s

Linear deposit s in GBM

Correct answer

Diffuse swelling of foot processes

 A 32-year old pregnant patient complained about a flank discomfort 0/1
which was later confirmed to be a flank mass over the right
retroperitoneal area,attached to the kidney. The mass measures 10 x 5
x 3 cm and presents with a soft, yellow-brown cut surface. THIS
BENIGN NEOPLASM ORIGINATES FROM WHICH OF THE FOLLOWING
TISSUE DERIVATIVES? *

Lipoblast s from t he perinephric fat

Mat ure mut at ed lipocyt es

Smoot h muscle cells of t he ut erus

Perivascular epit helioid cells

Alt ered fibroblast ic cells

Correct answer

Perivascular epit helioid cells

 A 16 year-old male was recently diagnosed with Nephrotic syndrome, 1/1
after tissue biopsy samples were sent for electron microscopy and
immunoflourescence. Despite aggressive treatment, the patient
continues to deteriorate. EM findings showed diffuse thickening of the
glomerular capillary walls. WHAT HISTOLOGIC FINDING MUST BE
PRESENT IN ORDER TO QUALIFY THE CASE AS MEMBRANOUS
NEPHROPATHY? *

Segment al effacement of t he epit helial foot processes.

Linear deposit s along t he endot helial side of t he GBM.

T here is an associat ed focal segment al glomerulosclerosis.

Immune complex deposit ion along t he subepit helial regions.

T hickening of t he GBM is primarily caused by C5-9 complement .

The tissue was taken from the kidney of a 52-year old male who 0/1
underwent left nephrectomy for a large “stag horn” calculus lodged in
the pelvo-calyceal system. STONE ANALYSIS OF THE LARGE CALCULUS
FROM THE KIDNEY OF THIS PATIENT WILL MOST LIKELY BE WHICH
TYPE? *

Triple phosphat es

Ammonium biurat e

Calcium carbonat e

Calcium oxalat es

Uric acid cryst als

Correct answer

Calcium oxalat es
 Which of the following statements regarding renal congenital anomalies is
NOT true? *

Approx 10% of newborns w/ significant malformat ions.

T went y percent of pedia CRF st em from renal dysplasias & hypoplasias

Aut osomal dominant polycyst ic kidney disease is a classic example.

Most arise from acquired development defect s rat her t han as herit able lesions.

All are correct .

Correct answer

Aut osomal dominant polycyst ic kidney disease is a classic example.

The tissue was taken from the kidney of a 52-year old male who 0/1
underwent left nephrectomy for a large “stag horn” calculus lodged in
the pelvo-calyceal system. WHICH OF THE FOLLOWING MICROSCOPIC
FEATURES WILL CONSISTENTLY BE OBSERVED IN THE KIDNEY OF THIS
PATIENT? *

Few hyalinized glomeruli, int erst it ial fibrosis, and at t enuat ed renal t ubules

T hyroidizat ion of t he kidneys associat ed wit h elevat ed creat inine levels.

A large floppy kidney wit h t hinned out cort ices and dilat ed pelvocalyx.

Numerous mononuclear inflammat ory cells wit hin a fibrot ic int erst it ium.

Art erioclerosis and hyaline degenerat ion of renal blood vessel walls

Correct answer

Few hyalinized glomeruli, int erst it ial fibrosis, and at t enuat ed renal t ubules
 Which of these conditions will least likely lead to development of 0/1
urinary tract infection? *

Hyperplast ic condit ions

Out flow obst ruct ion

Short er lengt h of uret hra

Regular mont hly menses

Diabet es mellit us t ype 2

Correct answer

Out flow obst ruct ion

An autopsy was performed on a 3-year old, poorly nourished, poorly 0/1

developed male child who died from complications of a disseminated
infection. This initially started as an untreated, large suppurative skin
infection over the left hand. Upon opening, multiple abscesses were
seen in most of the vital organs of the cadaver. WHICH OF THE
FOLLOWING WILL MOST LIKELY BE SEEN IN THE KIDNEYS OF THIS
PATIENT? *

Hypercellular glomeruli overlaid wit h mononuclear infilt rat es.

Diffuse renal t ubular cell necrosis and edema in t he int erst it ium.

Islands of necrosis bordered by edemat ous t issue and leaky capillaries.

Dilat ed renal t ubules filled wit h inflammat ory cells and cellular cast s.

Admixt ure of polygonal cells and mononuclear infilt rat es in some areas.

Correct answer

Islands of necrosis bordered by edemat ous t issue and leaky capillaries.

Which of the following has the highest percentage of progressing into 1/1
chronic GN? *

Crescent ic glomerulonephrit is

Membranous glomerulonephrit is

IgA nephropat hy

Focal segment al glomerulosclerosis

Membranoproliferat ive glomerulonephrit is

A 16 year-old male was recently diagnosed with Nephrotic syndrome, 1/1

after tissue biopsy samples were sent for electron microscopy and
immunoflourescence. Despite aggressive treatment, the patient
continues to deteriorate. WHICH OF THE FOLLOWING
MANIFESTATIONS IS LEAST LIKELY ASSOCIATED WITH NEPHROTIC
SYNDROME? *

Lipiduria

Hyperlipidemia

Daily loss of 3.5 gm prot ein

Anasarca

Severe hyperprot einemia

This type of drug-induced tubulointerstitial disease predisposes to 1/1
Transitional Cell Ca. *

Drug-induced int erst it ial nephrit is

Analgesic nephropat hy

Urat e nephropat hy

Nephrocalcinosis

Nephropat hy associat ed w/ NSAIDs

82) This crystal is usually associated with Bacterial infection. * 1/1

Cholest erol cryst als

Uric acid st ones

Triple phosphat e

Cyst eine cyst als

Calcium oxalat e
 An autopsy was performed on a 3-year old, poorly nourished, poorly 0/1
developed male child who died from complications of a disseminated
infection. This initially started as an untreated, large suppurative skin
infection over the left hand. Upon opening, multiple abscesses were
seen in most of the vital organs of the cadaver. IF URINALYSIS WAS
PERFORMED IN THIS PATIENT WHILE HE WAS HAVING ACUTE
PYELONEPHRITIS, WHICH OF THE FOLLOWING WILL BE THE TYPICAL
MICROSCOPIC PRESENTATION OF THE PATIENT'S SAMPLE? *

Dysmorphic red cells, renal t ubular cells, wispy st rands of mucus

Pyuria, a few red cells, WBC cast s, Bact eria and epit helial cells.

Massive pyuria, WBC cast s, Posit ive nit rit es, Posit ive prot ein,

Numerous epit helial cells, renal t ubular cells, mucus, bact eria

Pyuria, enumerable red cells, RBC and WBC cast s, loaded bact eria.

Correct answer

Pyuria, a few red cells, WBC cast s, Bact eria and epit helial cells.
*

RCCA,
RCCA, Chromophobe Collect ing
Clear
Oncocyt oma Papillary Renal Duct Score
Cell
t ype Carcinoma Carcinoma
t ype

Benign
t umor
arising from
collect ing 0/1
duct
int ercalat ed
cells

Most
common
t ype of 1/1
Renal Cell
Carcinoma.

Tumor
oft en
associat ed
w/
int erst it ial 1/1
foam cells
&
psamomma
bodies

Tumor
composed
of polygonal
cells w/
clear
cyt oplasm 1/1
int errupt ed
by a
delicat e
arborizing
vasculat ure

Row 6 ···/0

Malignant 0/1
t umor
derived
from
collect ing
duct
int ercalat ed
cells

Correct answers

RCCA, RCCA, Chromophobe Collect ing

Oncocyt oma Clear Cell Papillary Renal Duct
t ype t ype Carcinoma Carcinoma

Benign t umor
arising from
collect ing
duct
int ercalat ed
cells

Row 6

Malignant
t umor derived
from
collect ing
duct
int ercalat ed
cells
This stage of renal failure is characterized by azotemia, anemia and 1/1
hypertension with 20% to 50% of normal glomerular filtration rate. *

End-st age renal disease

Acut e renal failure

Renal insufficiency

Chronic renal failure

Diminish renal reserve

The case was that of a 3-year old child who was admitted after an 1/1
incidental finding of massive proteinuria in her urinalysis report. Aside
from occasional pus cells and sloughed off epithelial cells, the rest of
the patient’s urinalysis report was unremarkable. Physical examination
findings revealed no edema and hypertension. The mother could not
also recall any incident of gross hematuria. WHICH OF THE
FOLLOWING ELECTRON MICROSCOPY FINDINGS WILL MOST LIKELY
COINCIDE WITH THE PATIENT'S DIAGNOSIS? *

Diffuse t hinning of t he glomerular basement membrane.

Amyloid deposit ion wit hin t he glomerulus and int erst it ium.

Segment al sclerosis of t he glomerular capillary t uft s.

Result may show a seemingly normal kidney t issue sect ion.

Generalized effacement of epit helial foot processes.

A 32-year old pregnant patient complained about a flank discomfort 1/1
which was later confirmed to be a flank mass over the right
retroperitoneal area, attached to the kidney. The mass measures 10 x 5
x 3 cm and presents with a soft, yellow-brown cut surface. WHICH OF
THE FOLLOWING IS CONSIDERED AS THE MOST SIGNIFICANT CLINICAL
IMPORTANCE OF ANGIOMYOLIPOMA? *

Acut e or chronic kidney failure

Compromised renal funct ion

Malignant t ransformat ion

Impingement of vit al organs

Spont aneous hemorrhage

This stage of renal failure is characterized by overt uremia and edema. 1/1
*

End-st age renal disease

Chronic renal failure

Diminish renal reserve

Acut e renal failure

Renal insufficiency
 CASE. A 12-year old child was brought to the clinic because of sudden 0/1
puffiness of the face associated with episodes of passing tea-colored
urine. His mother complained that the child had a sore throat about a
week ago which resolved without treatment. WHICH OF THE
FOLLOWING WILL BE LEAST LIKELY SEEN IN THE URINE SAMPLE OF THIS
PATIENT? *

Red cell cast s

Occasional WBCs

immune complexes

Dysmorphic red cells

Occasional bact eria

Correct answer

immune complexes
The case was that of a 3-year old child who was admitted after an 1/1
incidental finding of massive proteinuria in her urinalysis report. Aside
from occasional pus cells and sloughed off epithelial cells, the rest of
the patient’s urinalysis report was unremarkable. Physical examination
findings revealed no edema and hypertension. The mother could not
also recall any incident of gross hematuria. WHAT IS THE MOST LIKELY
DIAGNOSIS IN THIS CASE? *

Minimal change disease

Membranous nephropat hy

Noninfect ious glomerulonephrit is

Erroneous urinalysis report

T hin basement membrane lesion

Which of the following are features of Postinfectious 1/1

Glomerulonephritis? *

Granular mesangial & GBM deposit s on EM

Global hypercellularit y

Proliferat ion of endot helial cells

Diffuse lymphocyt ic infilt rat ion

Subepit helial humplike deposit s on IF

A 12-year old child was brought to the clinic because of sudden 1/1
puffiness of the face associated with episodes of passing tea-colored
urine. His mother complained that the child had a sore throat about a
week ago which resolved without treatment. A KIDNEY PUNCH BIOPSY
PERFORMED ON THIS PATIENT WILL MOST LIKELY PRESENT WITH
WHICH HISTOPATHOLOGIC FEATURES? *

Glomerulosclerosis

Swollen renal t ubular cells

inflammat ory cells inside glomeruli

Art eriosclerosis

Diffuse glomerular at rophy

Acute tubular necrosis. *

Init iat ion Recovery

Maint enance
phase of phase of Score
phase of AT N
AT N AT N

Concent rat ing

1/1
abilit y improves

Charact erized
by salt & wat er 1/1
overload

Met abolic
acidosis
1/1
commonly
observed

Oliguria
1/1
predominat es

Dominat ed by
t he incit ing 1/1
event

Which of the following statements correctly defines Acute Renal 0/1

Failure? *

Once it occurs, it gradually progresses t o Chronic renal failure.

Charact erized by decreased or absent urine out put .

Manifest s when injury is localized t o t he renal blood vessels

Affect ed pat ient s present wit h uremic sympt oms at t he onset .

T he pat ient s have highly elevat ed Creat inine levels from t he st art .

Correct answer

Charact erized by decreased or absent urine out put .

Which of the following is not an essential compartment of the kidneys? 1/1
*

Glomerulus

Renal blood vessels

Int erst it ium

Renal t ubules

Pelvocalyx
Cystic kidney diseases. *

Adult Childhood Dialysis-

Medullary
polycyst ic polycyst ic associat ed
sponge Nephronopht hisis Score
kidney kidney cyst ic
kidney
disease disease disease

Associat ed
wit h
congenit al 1/1
hepat ic
fibrosis

Mult iple,
cylindrically
dilat ed
collect ing
duct s 1/1
orient ed at
right
angles t o
cort ex

One variant
has Renal-
1/1
Ret inal
dysplasia

Row 7 ···/0

Mult iple
cyst ic
dilat ions in
t he 1/1
medullary
collect ing
duct s

Mut at ions
involve
Polycyst in
1/1
1 and
Polycyst in
2

Cyst oft en 1/1

cont ains
calcium
oxalat e
cryst als

Correct answers

Adult Childhood Dialysis-

Medullary
polycyst ic polycyst ic associat ed
sponge Nephronopht hisis
kidney kidney cyst ic
kidney
disease disease disease

Row 7

These are a constellation of clinical signs and symptoms associated 1/1

with azotemia. *

Acut e kidney injury

Nephrot ic syndrome

Uremia

Nephrit ic syndrome

End-st age kidney disease

Which of the following describes Azotemia? * 1/1

Ant igen-ant ibody react ion is most oft en involved

Post renal condit ion is brought about by renal art ery occlusion

Increase glomerular filt rat ion rat e

Increased in blood urea and creat inine levels.

Prerenal condit ion is secondary t o renal hyperperfusion.

This is the most characteristic feature seen in Minimal change disease. 1/1
*

Heavy prot einuria

Effacement of foot processes

Absence of immune deposit s

Dramat ic response t o st eroid t herapy

Normal glomeruli
Renovascular diseases. *

Renal Sickle
Benign Accelerat ed T hrombot ic
art ery disea
nephrosclerosis nephrosclerosis microangiopat hies
st enosis nephrop

Associat ed
wit h
hyperplast ic
art eriopat hy
(onion-
skinning).

Most cases
are
superimposed
on preexist ing
benign
essent ial
hypert ension.

Majorit y (70%)
of cases
caused by
obst ruct ive
at heromat ous
plaque.

Associat ed
wit h int ake of
food
cont aminat ed
wit h Shiga-like
t oxins.

Small kidneys
wit h diffuse
granular
surfaces.
 Which of the following descriptions is least likely attributable to renal 0/1
cell carcinoma? *

A st riking charact erist ic of RCCA is it s abilit y t o invade t he bladder.

T he most common rout es of met ast asis are t he lungs and t he bones.

Occurrence of t his malignancy may somet imes lead t o amyloidosis.

Radical nephrect omy has been t he current t reat ment of choice.

T he neoplasm is t he most common t ype of kidney cancer in adult s.

Correct answer

Occurrence of t his malignancy may somet imes lead t o amyloidosis.

The crescent formation seen in RPGN is composed mainly of which of 1/1

the following cells? *

T issue macrophages

Epit helial cells

Fibroblast s

Immune complexes

Mesangial cells
 A patient was diagnosed with Focal Segmental Glomerulosclerosis. 0/1
This was done after an extensive work-up following a diagnosis of
Sickle Cell Disease. WHICH OF THE FOLLOWING IS LEAST LIKELY
ASSOCIATED WITH THE TYPICAL HISTOLOGIC MORPHOLOGY OF
FOCAL SEGMENTAL GLOMERULOSCLEROSIS? *

Diffuse effacement of foot processes exclusively seen in sclerot ic areas.

Collapsing glomerulopat hy t ypically associat ed wit h prominent t ubular injury.

T here is collapse of capillary loops, increase in mat rix , and hyalinosis.

IF microscopy shows IgM and complement C3 deposit s in sclerot ic areas.

Glomeruli t hat do not show segment al lesions appear normal in light microscopy.

Correct answer

Diffuse effacement of foot processes exclusively seen in sclerot ic areas.

A patient with acute glomerulonephritis was admitted for 1/1
complications associated with his disease. The doctors would want to
determine the current status of his kidney so that a CT-scan-guided
punch biopsy was performed. The tissue sections showed enlarged
glomeruli with evident hypercellularity. The bowman’s space was either
severely narrowed or obliterated by proliferating epithelial cells. WHICH
OF THE FOLLOWING STATEMENTS BEST DESCRIBE THIS TYPE OF
GLOMERULONEPHRITIS? *

Mononuclear cell infilt rat ion cause basement membrane damage.

Immune complex deposit ion in t he kidney, lungs, liver, and int est ine.

Pat ient s may survive for 10 t o 15 years despit e severe prot einuria.

Rapid and progressive loss of renal funct ion wit h severe oliguria.

Mesangial cells proliferat e t o expand t he involved glomeruli.

The following clinical features seen in chronic pyelonephritis & reflux 1/1
nephropathy foretell a poor prognosis. *

Prot einuria and focal segment al glomerulosclerosis

Gross hemat uria wit h glomerular crescent s.

Focal segment al glomerulosclerosis.

Diffuse glomerular basement t hickening

Prot einuria associat ed wit h gross hemat uria.

 Which of the following are microscopic features of 0/1
Membranoproliferative GN (MPGN)? *

Diffuse effacement of foot processes and pariet al cell hypert rophy

T hickened capillary loops wit h glomerular cell proliferat ion.

Inflammat ory cell infilt rat es causing t ubuloint erst it ial necrosis.

Double cont our appearance of immune complex deposit ion.

Glomeruli appear glassy due t o mesangial proliferat ion.

Correct answer

T hickened capillary loops wit h glomerular cell proliferat ion.

Match the following Glomerular diseases to their typical presentation. *

Acut e Rapidly
Focal Seg. Tubuloint erst it ial He
Proliferat ive Progressive
Glomerulosclerosis fibrosis Ne
GN GN

Occurs 1 t o 4
weeks aft er
cut aneous or
pharyngeal st rep
infect ion

Due t o ischemia &

inflammat ion in
t he int erst it ium &
direct injury t o
t ubular cells

Diffuse
glomerulonephrit is
w/ global
hypercellularit y
due t o Neut rophil
& monocyt e
infilt rat ion

Pariet al cell
proliferat ion &
inflammat ory cell
migrat ion int o
Bowman space

Tot al glomerular
scarring w/
prot einuria &
uremia
A 55-year old man underwent partial cystectomy for a papillomatous 1/1
growth located near the trigone of the urinary bladder, seen during
cystoscopy. He gave a history of dysuria since two weeks previously
and a vague mass that he could palpate over his hypogastrium. The
urinary bladder shows an exophytic mass arising from the mucosa,
which had a broad base, soft consistency, and grayish tan color. The
mass measures 5 x 4 x 3 cm. On sectioning, the tumor is noted to have
invaded the underlying muscular layer. WHICH OF THE FOLLOWING
STATEMENTS BEST EXPLAIN THE SIGNIFICANCE OF THE TUMOR
INVADING THE UNDERLYING DETRUSOR MUSCLE? *

T he risk of gross hemat uria increases wit h t he dept h of t umor invasion.

Papillomat ous form of Urot helial carcinoma is t he most common cause.

Muscle layer involvement indicat es t he neoplasm comes from t he prost at e.

Invasion of t he underlying muscular layer signifies a poorer prognosis.

Muscle ext ension coincides wit h 90% - 95% involvement of t he renal pelvis.
 A patient was diagnosed with Focal Segmental Glomerulosclerosis. 0/1
This was done after an extensive work-up following a diagnosis of
Sickle Cell Disease. WHICH OF THE FOLLOWING STATEMENTS IS LEAST
LIKELY ASSOCIATED WITH FOCAL SEGMENTAL
GLOMERULOSCLEROSIS? *

Can be seen as manifest at ion of inherit ed nephrot ic syndrome.

Clinically manifest ed as subacut e onset of nephrot ic syndrome.

T he pat ient is most likely an adult at t he onset of t he disease.

Because t he disease is focal, hypert ension is not observed.

Commonly present s wit h microscopic hemat uria and mild azot emia.

Correct answer

Because t he disease is focal, hypert ension is not observed.

Which of the following is not a feature of IgA Nephropathy? * 1/1

Recurrence of IgA deposit s is common in renal allograft s.

Occasionally present s wit h Glomerular hemat uria.

Increased frequency is observed in liver pat hology.

Poorer prognosis is associat ed wit h an older age of onset .

Act ivat ion of Alt ernat e complement pat hway is common.

A 58-year old man complained of vague back and right lumbar pain of 1/1
one month duration which was followed by hematuria the day prior to
his admission. Physical examination revealed an enlarged right kidney.
Ultrasound showed a solid mass within the right kidney. The patient
underwent a Right Nephrectomy. The excised kidney showed a rubbery,
nodular mass occupying almost the entire lower pole of the kidney. The
renal capsule was adherent to the surface of the mass. Cut section of
the mass reveals a fairly well-demarcated border adjacent to the
uninvolved renal parenchyma. The mass had variegated areas of
hemorrhage, golden yellow areas admixed with pearly-white and
translucent edematous areas. WHICH OF THE FOLLOWING IS
CONSIDERED AS THE MOST SIGNIFICANT RISK FACTOR FOR RENAL
CELL CARCINOMA? *

Alcohol abuse

Tobacco use

Chronic kidney disease

Tuberous sclerosis

Alcohol and Tobacco

Match the following Glomerular diseases to their clinical characteristics. *

Minimal
Membranous Focal Seg. Membranoproliferat ive
Change
Nephropat hy Glomerulosclerosis GN Nep
Disease

Common
cause of
adult -onset
nephrot ic
syndrome

Diffuse
effacement
of foot
processes of
visceral
epit helial cells
in EM

Major cause
of nephrot ic
syndrome in
children

Most cases
present wit h
C3 nephrit ic
fact or in
serum

Charact erized
by gross
hemat uria
following
respirat ory, GI,
or urinary
infect ion
 Bacterial elements reach the kidney through the blood stream and from 0/1
the lower urinary tract. Which of the following conditions may
predispose a patient to acquire acute pyelonephritis through the
hematogenous route? *

GUT inst rument at ion and in decrease GFR

Low renal blood flow and in Diabet es mellit us

GI malignancies wit h glomerular damage

Benign prost at ic hyperplasia and in uret hrit is

Uret eral obst ruct ion and in debilit at ed pat ient s

Correct answer

Uret eral obst ruct ion and in debilit at ed pat ient s

 A 35-year old female came to the emergency room in respiratory 0/1
distress. Further examination also revealed that she had fever,
hypertension and lower extremity edema. Laboratory work-up done on
the following day led to the diagnosis of Nonstreptococcal Acute
Glomerulonephritis. WHICH OF THE FOLLOWING STATEMENTS IS
CONSISTENT WITH THIS PATIENT'S CONDITION? *

Disease is caused by Hepat it is B and C exposure.

Charact erized by linear deposit s seen in immunofluorescence.

T he involved kidney appears normal in light microscopy.

Diffuse dest ruct ion of t he glomerular capillary walls.

Immune complex deposit ion in t he subendot helial regions and GBM.

Correct answer

Disease is caused by Hepat it is B and C exposure.

This form of Chronic pyelonephritis begins in childhood as a result of 1/1

infections superimposed on a longstanding case of urine backflow. *

Focal sclerosis

Benign nephrosclerosis

Obst ruct ive pyelonephrit is

Reflux nephropat hy

Tubular dysfunct ion

 Which of the following is an important complication of 1/1
Angiomyolipoma? *

Tumor bulk

Compression of vit al st ruct ures

Malignancy

Spont aneous hemorrhage

T issue necrosis

Which of the following correctly describes the etiology and 0/1

pathophysiology of renal glomerular diseases? *

T he basic similarit y of all glomerular diseases is immune mechanism.

In primary glomerulonephrit is, t he kidney exhibit s hydronephrosis.

T he kidney event ually becomes damage as one get s older.

T he diseased glomeruli demonst rat e leakage of prot eins.

T issue changes seen in primary and secondary are dist inct from each ot her.

Correct answer

T he diseased glomeruli demonst rat e leakage of prot eins.

Accumulation of this crystal in the urine is caused by genetic defects in 1/1
renal amino acid resorption. *

Triple phosphat e

Calcium oxalat e

Cholest erol cryst als st ones

Uric acid

Cyst eine cyst als

Match the syndrome to its common presentation. *

Eit her Neit her

Nephrit ic Nephrot ic
Nephrit ic/Nephrot ic Nephrit ic/Nephrot ic Score
syndrome syndrome
syn. syn.

Present s
wit h 0/1
hemat uria

Transform
int o Renal
1/1
Cell
Carcinoma

Due t o
Glomerular 1/1
injury

Prot einuria
of >3.5 gms 1/1
per day

Associat ed
wit h 0/1
Hypert ension

Correct answers

Eit her Neit her

Nephrit ic Nephrot ic
Nephrit ic/Nephrot ic Nephrit ic/Nephrot ic
syndrome syndrome
syn. syn.

Present s wit h
hemat uria

Associat ed
wit h
Hypert ension
Microscopic evaluation of the processed specimen showed lobules or 1/1
islands of tumor cells with vesicular nuclei, prominent cell membranes
and pale eosinophilic cytoplasm. Often halo forms around the nucleus
of the individual tumor cells. WHICH TYPE OF RENAL CELL CARCINOMA
HAS THIS HISTOLOGIC PATTERN? *

Xp11 t ranslocat ion carcinoma

Chromophobe Renal Cell Carcinoma

Bellini Duct Renal Cell Carcinoma

Clear cell Renal Cell Carcinoma

Papillary Renal Cell Carcinoma

A patient was diagnosed with Focal Segmental Glomerulosclerosis. 1/1

This was done after an extensive work-up following a diagnosis of
Sickle Cell Disease. WHICH OF THE FOLLOWING FACTORS IS
ASSOCIATED WITH RAPID PROGRESSION OR POOR PROGNOSIS OF
FOCAL SEGMENTAL GLOMERULOSCLEROSIS? *

Early init iat ion of st eroids

Age of disease onset

Presence of a t ip variant

Severit y of hemat uria

Degree of prot einuria

 Revascularization surgery cures 70% to 80% of this lesion. * 1/1

T hrombot ic microangiopat hies

Renal art ery st enosis

Malignant hypert ension

SCD nephropat hy

Benign nephrosclerosis

This emerging viral etiology for renal infections is commonly observed 0/1
among renal allografts. *

Herpes Simplex virus

Human papillomavirus

Cyt omegalovirus

Polyomavirus

Human Immunodeficiency Virus

Correct answer

Polyomavirus
 Most common form of renal crystal. * 1/1

Uric acid st ones

Calcium oxalat e

Leucine cryst als

Cyst eine cyst als

Triple phosphat e

Fibrinoid necrosis and intravenous thrombosis are characteristic 0/1

features. *

Renal infarct

Benign nephrosclerosis

Fibromuscular dysplasia

Accelerat ed nephrosclerosis

SCD nephropat hy

Correct answer

Accelerat ed nephrosclerosis
 Which of the following underlies the mechanism of injury seen in 0/1
Goodpasture syndrome? *

Disappearance of GBM

Granular deposit s in IF

Linear pat t ern in IF

Ant ibodies t o Megalin

Ant ibodies against endot helials cells

Correct answer

Linear pat t ern in IF

Which of the following features is NOT true regarding Renal Papillary 1/1
Adenoma? *

Indist inguishable from Low Grade Renal Cell Carcinoma, Papillary t ype.

Tumors are small and yellow, most ly observed along t he cort ical region.

T he t umor is a benign lesion arising from t he kidneys.

A size cut -off of 5 cm separat es t hose t hat met ast asize from t hose t hat
don’t .

Tumor cells are composed of vacuolat ed epit helial cells, forming t ubules and
complex branching st ruct ures.
 Which of the following underlies the pattern of injury demonstrated in 0/1
Cell-mediated injury in Glomerulonephritis? *

GBM t hinning

Nodular sclerosis

Mesangial cell proliferat ion

Renal vessel hypert rophy

Effacement of foot processes

Correct answer

Effacement of foot processes

Which of the following characterizes HIV-associated Nephropathy? * 1/1

Epit helial hypert rophy wit h Endot helial t ubuloret icular inclusions.

Diffuse t hickening of glomerular capillary walls.

Glomerulopat hy associat ed wit h minimal change disease.

Commonly observed among children aged 2 t o 6 years old.

Oblit erat ion of t he bowman space due t o inflammat ion.

Which of the following statements regarding Nephrotic Syndrome is 1/1
incorrect? *

Hypoprot einemia can be document ed on t he pat ient ’s blood.

Charact erized by massive prot einuria (>3.5gm/day).

Edema is aggravat ed by sodium and wat er ret ent ion.

Albuminuria is readily seen in t he pat ient ’s urine.

Syst emic edema is brought about by increased hydrost at ic pressure.

Which of the following are major features of progressive renal 1/1

damage? *

Chronic inflammat ory infilt rat es wit h Hydronephrosis.

Hydronephrosis wit h Diffuse parenchymal damage

Focal segment al glomerulosclerosis & Tubuloint erst it ial fibrosis

Glomerular hyalinizat ion & Int erst it ial fibrosis

Acut e t ubular necrosis & Art eriolosclerosis

 A patient with acute glomerulonephritis was admitted for 0/1
complications associated with his disease. The doctors would want to
determine the current status of his kidney so that a CT-scan-guided
punch biopsy was performed. The tissue sections showed enlarged
glomeruli with evident hypercellularity. The bowman’s space was either
severely narrowed or obliterated by proliferating epithelial cells. WHAT
IS THE MOST LIKELY TYPE OF GLOMERULAR DISEASE DOES THIS
PATIENT HAVE? *

Post st rept ococcal glomerulonephrit is

Membranoproliferat ive glomerulonephrit is

Post infect ious glomerulonephrit is

Crescent ic glomerulonephrit is

Membranous nephropat hy

Correct answer

Crescent ic glomerulonephrit is

Which of the following statements pertaining to Analgesic nephropathy 1/1

is incorrect? *

Early manifest at ions include polyuria and increased st one format ion.

Nephropat hy charact erized by uret eral reflux and necrosis of t he renal pelvis.

Papillary necrosis occurs as a consequence of direct t oxicit y and ischemia.

T hese are all correct .

T here is an increased risk of Transit ional cell carcinoma of t he renal pelvis.

 In the pathogenesis of Acute Tubular Necrosis, which of the following 0/1
statements is not true? *

Tubular epit helial cells can wit hst and long periods of ischemia and chronic
exposure t o t oxins.

Art eriolar vasoconst rict ion leads t o increased endot helin and decreased nit ric
oxide and prost acyclin.

Glomerular ult rafilt rat ion is direct ly affect ed by ischemia and t oxins at t ribut ed t o
mesangial cont ract ion

Tubular obst ruct ion is caused by necrot ic and apopt ot ic epit helial cells and
prot einaceous mat erial.

Reversible and irreversible t ubular damage are t he primary event s leading t o

diminished renal funct ion.

Correct answer

Tubular epit helial cells can wit hst and long periods of ischemia and chronic
exposure t o t oxins.

This type of kidney pathology is characterized by features of tubular 1/1

dysfunction without the signs & symptoms associated with
nephritic/nephrotic syndrome. *

Glomerulosclerosis

Minimal change disease

Obst ruct ive uropat hy

Tubuloint erst it ial diseases

Hyaline art eriosclerosis

Which of the following is the etiologic agent for Acute proliferative 1/1
glomerulonephritis? *

Non-hemolyt ic (Viridans) St rep

Group B St rept ococcus

St aphylococcus aureus

Pseudomonas spp.

Group A bet a-hemolyt ic st rep

Which of the following statements is not related to the recovery phase 1/1
of Acute kidney injury? *

Hyaline vascular t hickening

Improvement of concent rat ing abilit y

Oliguria of 40 t o 400 ml/day

Normal glomerular filt rat ion rat e

Rest orat ion of t ubular funct ion

 Which of the following statements regarding acute pyelonephritis is 0/1
not true? *

Unt reat ed cases can lead t o abscess format ion in t he renal parenchyma.

Classic signs & sympt oms include flank pain, hemat uria, fever, and RBC cast s.

Pat chy, suppurat ive inflammat ion associat ed wit h t ubular necrosis.

May recur or progress in t he presence of vesicouret eral reflux or obst ruct ion.

Most commonly result s from an ascending infect ion from t he bladder.

Correct answer

Unt reat ed cases can lead t o abscess format ion in t he renal parenchyma.
Renal tubular diseases and their clinical presentation. *

Chronic Drug-
Ne
Pyelonephrit is pyelonephrit is induced Analgesic
a
& UT I & reflux int erst it ial nephropat hy
w
nephropat hy nephrit is

Membranous nephropat hy
of uncert ain et iology

Met abolit es of
Phenacet in/Acet aminophen
deplet e t ubular cells of
Glut at hione & induce
oxidat ive met abolit es

Condit ion occurs more

frequent ly among women

Seen in childhood from

infect ions superimposed on
congenit al vesicouret eral
reflux

Idiosyncrat ic
hypersensit ivit y react ion
occurring 2 wks post
exposure
The case was that of a 16-year old female diagnosed with 1/1
Membranoproliferative Glomerulonephritis. The disease was
characterized by chronic episodes of hematuria and mild proteinuria,
which was non-responsive to steroids and immunosuppressive drugs.
WHICH OF THE FOLLOWING TYPES OF MPGN IS A COMPONENT OF C3
GLOMERULOPATHIES? *

MPGN Type IVa

MPGN Type IVb

MPGN Type I

MPGN Type III

MPGN Type II

What is the most common clinical presentation of Urothelial carcinoma 1/1

among patients? *

Int ermit t ent dysuria

Hemat uria

Mild flank pain

Palpable mass

Hesit ancy in urinat ion

Which of the following is NOT a cause of Acute Tubular Necrosis (ATN)? 1/1
*

Ischemic condit ions

Immune complex deposit ion

Direct t oxic injury

Urinary obst ruct ion

Tubuloint erst it ial nephrit is

This type of Crescentic Glomerulonephritis is associated with absence 1/1

of immune complex deposits. *

Type I RPGN

Heymann Nephrit is

Asympt omat ic prot einuria

Type III RPGN

Type II RPGN
The following are features of Benign Nephrosclerosis, except: * 1/1

Pat hology associat ed wit h renal art eriolar sclerosis

Kidneys are small w/ diffuse granular surfaces (scarring)

Diffuse ischemic at rophy of t he nephrons

Large muscular art eries show fibroelast ic hyperplasia w/ medial & int imal
t hickening

T here are no except ions

In patients with chronic pyelonephritis and reflux nephropathy who 1/1

develop proteinuria, this type of lesion is observed in their kidneys. *

Basement membrane t hickening

Focal segment al glomerulosclerosis

Amyloid body deposit ion

Hyaline degenerat ion/art eriosclerosis

Int erst it ial fibrosis and scarring

The case was that of a 16-year old female diagnosed with 1/1
Membranoproliferative Glomerulonephritis. The disease was
characterized by chronic episodes of hematuria and mild proteinuria,
which was non-responsive to steroids and immunosuppressive drugs.
WHICH OF THE FOLLOWING STATEMENTS REGARDING MPGN IS TRUE?
*

Charact erized by alt erat ions in t he glomerular basement membrane.

Duplicat ion of endot helial cells charact erizes it s double cont our appearance.

T he involved glomerular unit s appear enlarged and are hypercellular

Some pat ient s are not ed t o have developed numerous crescent s.

Account s for 10% of cases of nephrot ic syndrome in children & young adult s.

Which species of microorganism is most commonly associated with 1/1

urinary tract infection. *

Gardnerella species

Trichomonas species

Gram negat ive ent erics

Lact obacillus species

St aphylococcus species

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