Nephrotic Syndrome

Question 1

A 6-year-old child presents with sudden-onset edema and heavy proteinuria. The renal biopsy shows no glomerular changes on light microscopy, negative immunofluorescence, and podocyte effacement on electron microscopy. What is the most likely diagnosis?

A. FSGS
B. Minimal change disease (MCD)
C. Membranoproliferative glomerulonephritis
D. Lupus nephritis

Answer 1

B

Question 2

In which of the following conditions is minimal change disease commonly associated?

A. Rheumatoid arthritis
B. Hodgkin’s disease
C. Systemic lupus erythematosus
D. Sarcoidosis

Answer 2

B

Question 3

Which of the following is the first-line treatment for MCD in adults?

A. Cyclosporine
B. Mycophenolate mofetil
C. Prednisone
D. Cyclophosphamide

Answer 3

C

Question 4

What is the mechanism thought to be responsible for podocyte damage in MCD?

A. Immune complex deposition
B. Complement activation
C. T-cell-mediated injury
D. Antibody-mediated attack on podocytes

Answer 4

C

Question 5

Which of the following statements regarding the relapse of MCD is TRUE?

A. Relapses occur in only 30% of children after the first remission.
B. Relapse rates decrease after puberty.
C. Relapse is uncommon in adults and usually responds to therapy.
D. Early relapse predicts a favorable long-term outcome.

Answer 5

B

Question 6

Nil leasion

Answer 6

MCD

Question 7

MCD on renal biopsy

Answer 7

No glomerular lesion by light microscopy and is negative for deposits by immunofluorescent microscopy

Small amounts of IgM in the mesangium

Question 8

MCD Pathogenesis

Answer 8

Disturbance related to T-cell response or expression of CD80 or CD40

Question 9

Presents clinically with the abrupt onset of edema and nephrotic syndrome accompanied by acellular urinary sediment.

Answer 9

MCD

Question 10

Average urine protein excretion reported in 24 h is 10 g with severe hypoalbuminemia.

Answer 10

MCD

Question 12

First line of therapy MCD

Answer 12

Prednisone

Question 13

It refers to a pattern of renal injury characterized by segmental glomerular scars that involve some but not all glomeruli (focal);

Answer 13

FSGS

Question 14

Represents up to onethird of cases of nephrotic syndrome in adults

Answer 14

FSGS

Question 15

Treatment of patients with FSGS should include ______.

Answer 15

inhibitors of the renin-angiotensin system

Question 16

Which of the following histologic findings is characteristic of focal segmental glomerulosclerosis (FSGS)?

A. Global glomerular sclerosis in all glomeruli
B. Segmental glomerular scarring in some glomeruli
C. Membranous deposits with “spikes” on silver stain
D. Endocapillary proliferation with crescent formation

Answer 16

B

Question 17

Accounts for ~25% of cases of nephrotic syndrome in adults, with a peak incidence between the ages of 30 and 50 years and a male-to-female ratio of 2:1. I

Answer 17

Membranous Glomerulonephritis

Question 18

The presence of subendothelial deposits or the presence of tubuloreticular inclusions strongly points to a diagnosis of ____

Answer 18

membranous lupus nephritis

Question 19

Male gender, older age, hypertension, and the persistence of nephrotic-range proteinuria are associated with worse prognosis.

Answer 19

Membranous Glomerulonephritis

Question 20

A 62-year-old woman with a history of hepatitis B infection presents with nephrotic syndrome. Renal biopsy shows subepithelial deposits on light microscopy. What is the most likely cause of her nephrotic syndrome?
A. Diabetic Nephropathy
B. Membranous Nephropathy (MGN)
C. Minimal Change Disease (MCD)
D. Focal Segmental Glomerulosclerosis (FSGS)

Answer 20

Answer: B. Membranous Nephropathy (MGN

Question 21

A 45-year-old woman presents with nephrotic syndrome. She is diagnosed with primary membranous nephropathy. What is the most common autoantibody associated with this condition?
A. Anti-GBM antibody
B. PLA2R antibody
C. Anti-dsDNA antibody
D. C3 nephritic factor

Answer 21

B

Question 22

A 28-year-old man presents with nephrotic-range proteinuria, hematuria, and sensorineural deafness. Renal biopsy reveals areas of thin and thickened GBM with “basket-weave” appearance. What is the most likely diagnosis?
A. Thin Basement Membrane Disease
B. Alport’s Syndrome
C. Membranous Nephropathy
D. Anti-GBM Disease

Answer 22

B

Question 23

A 40-year-old man with a history of poorly controlled diabetes mellitus presents with proteinuria and declining GFR. Renal biopsy shows mesangial expansion, Kimmelstiel-Wilson nodules, and GBM thickening. What is the most likely diagnosis?
A. Focal Segmental Glomerulosclerosis (FSGS)
B. Diabetic Nephropathy
C. Membranous Nephropathy (MGN)
D. Minimal Change Disease (MCD)

Answer 23

B

“Some patients also develop eosinophilic, PAS+ nodules called Kimmelstiel-Wilson nodules.”

Question 24

A 48-year-old African American man with hypertension and APOL1 polymorphism presents with nephrotic syndrome. What is the most likely renal lesion?
A. Focal Segmental Glomerulosclerosis (FSGS)
B. Membranous Nephropathy (MGN)
C. Minimal Change Disease (MCD)
D. Diabetic Nephropathy

Answer 24

A

Question 25

A 50-year-old man presents with nephrotic syndrome and a history of long-standing type 1 diabetes. Which renal lesion is most likely?
A. FSGS
B. Kimmelstiel-Wilson nodules
C. Membranous Nephropathy
D. Minimal Change Disease

Answer 25

B