RENAL ASSESSMENT

Question 1

What is the MOST likely pathology behind rapidly progressive glomerulonephritis with concomitant diffuse pulmonary hemorrhage?

• Renal pathology secondary to adaptive changes from systemic disease
• Presence of circulating anti-glomerular basement membrane antibodies
• Pathology is currently unknown or is idiopathic
• Diffuse inflammatory response after severe or systemic infection

Answer 1

Presence of circulating anti-glomerular basement membrane antibodies

Question 2

44-year-old male visited an out-patient department with symptoms of nausea, vomiting, and general weakness that had developed over the previous 2 weeks. He had history of medication, nonsteroidal anti-inflammatory drugs. On admission to general ward, his serum creatinine level was markedly elevated. A renal biopsy was done and 30 mg of corticosteroid per day was immediately initiated. Subsequently, his serum creatinine level and uremic symptoms dramatically decreased. Based on the case, expected findings on glomerular electron microscopic examination will demonstrate:

Answer 2

Subepithelial immune complex “humps”

Question 3

33-year-old man presents to the clinic with gross hematuria. About 5 days ago, he had fever, runny nose, and sore throat. He is currently asymptomatic. There is no family history of hematuria or renal failure. Physical exam and vital signs are normal. Urinalysis demonstrate dysmorphic RBC’s, RBC’s cast, and trace proteinuria. Serum chemistries are normal. Serum complement and other serologies are normal. Hematuria persist 1 week later. What is the most likely diagnosis:

Answer 3

Berger disease

Question 4

The renal lesions associated with diabetes mellitus are the following EXCEPT:

• Glycogen deposits in the tubular epithelium
• Nodular glomerulosclerosis
• Acute pyelonephritis
• Nephrolithiasis

Answer 4

Nephrolithiasis

Question 5

Transitional cell carcinoma of the urinary bladder are associated with the ff EXCEPT:

• Prolonged salicylate intake
• Aniline dyes
• Schistosomiasis of the bladder
• Heavy cigarette smoking

Answer 5

Prolonged salicylate intake

Question 6

Most common WHO class of Lupus Nephritis.

• no lesions
• focal segmental
• diffuse proliferative
• mesangial

Answer 6

diffuse proliferative

Question 7

In addition to nephritic injury, the other main cause of acute tubular necrosis is:

Answer 7

Ischemia

Question 8

The most characteristic renal finding in diabetes mellitus

• Diffuse glomerulosclerosis
• Hyaline arteriolosclerosis
• Acute pyelonephritis
• Nodular glomerulosclerosis

Answer 8

Nodular glomerulosclerosis

Question 9

Microscopic features of this lesion in the urinary bladder revealed Infiltration with large foamy macrophages with multinucleated giant cells interspersed with lymphocytes. Michaelis Gutmann bodies are present.

Answer 9

Malakoplakia

Question 10

A 28 y/o woman presented with fever, dysuria, urinary frequency and flank tenderness. Urinalysis showed abundant WBC and bacteria. The most likely etiology is:

Answer 10

E. coli

Question 11

Coarse asymmetric renal corticomedullary scarring, deformity of the renal pelvis and calyces, atrophic tubules with eosinophilic casts all suggest:

Answer 11

Chronic pyelonephritis

Question 12

A 28 year old primigravida had hypotensive shock because of postpartum hemorrhage. Her urine output ranged from 60 - 200 ml/24 hours. The basic kidney lesion to explain this decreased urine output among these patients is:

Answer 12

Acute tubular necrosis

Question 13

The most common cause of death in Multiple Myeloma is:

Answer 13

infection

Question 14

Diffuse effacement of foot processes is characteristic of:

Answer 14

Idiopathic rapidly progressive glomerulonephritis

Question 15

Which of the following tests is most valuable in confirming Goodpasture’s syndrome?

• diffuse linear staining of GBM with IgG
• diffuse thickening of GBM on electron microscopy
• granular lumpy bumpy deposits of IgG
• urine culture for resistant E.coli

Answer 15

diffuse linear staining of GBM with IgG

Question 16

The renal lesions associated with diabetes mellitus are the following EXCEPT:

• Nodular glomerulosclerosis
• Acute pyelonephritis
• Glycogen deposits in the tubular epithelium
• Nephrolithiasis

Answer 16

Nephrolithiasis

Question 17

Of the complications of acute pyelonephritis enumerated below, one does not belong:

• Acute episodes of paroxysmal HPN
• Retroperitoneal abscess formation
• Pyonephrosis
• Renal papillary necrosis

Answer 17

Retroperitoneal abscess formation

Question 18

28 year old primigravida had hypotensive shock because of postpartum hemorrhage. Her urine output ranged from 60 - 200 ml/24 hours. The basic kidney lesion to explain this decreased urine output among these patients is:

Answer 18

Acute tubulointerstitial nephritis

Question 19

Approximately 2 weeks after an episode of pharyngitis, a 13-year old girl abruptly becomes tired, febrile, and nauseous. She has markedly reduced urine output that is cola-colored. Urinalysis shows proteinuria, hematuria, and RBC casts. How many percent of adults recover without incident?

Answer 19

60%

Question 20

Approximately 2 weeks after an episode of pharyngitis, a 13-year old girl abruptly becomes tired, febrile, and nauseous. She has markedly reduced urine output that is cola-colored. Urinalysis shows proteinuria, hematuria, and RBC casts.How many percent of children recover without incident?

Answer 20

80%

Question 21

Approximately 2 weeks after an episode of pharyngitis, a 13-year old girl abruptly becomes tired, febrile, and nauseous. She has markedly reduced urine output that is cola-colored. Urinalysis shows proteinuria, hematuria, and RBC casts. Describe the cellularity of the glomerulus in this condition.

Answer 21

Hypercellular

Question 22

Approximately 2 weeks after an episode of pharyngitis, a 13-year old girl abruptly becomes tired, febrile, and nauseous. She has markedly reduced urine output that is cola-colored. Urinalysis shows proteinuria, hematuria, and RBC casts. What inflammatory cells are increased in this condition?

Answer 22

Neutrophils

Question 23

Approximately 2 weeks after an episode of pharyngitis, a 13-year old girl abruptly becomes tired, febrile, and nauseous. She has markedly reduced urine output that is cola-colored. Urinalysis shows proteinuria, hematuria, and RBC casts. What other examination may augment in the diagnosis of the disease?

Answer 23

CRP

Question 24

Ten days after recovering from a mild respiratory tract infection, an otherwise healthy, 22 year old man starts passing dark urine; urinalysis shows dysmorphic erythrocytes. The hematuria subsides in 1 week, only to return four more times in the next year. Give your impression.

Answer 24

IgA nephropathy

Question 25

Ten days after recovering from a mild respiratory tract infection, an otherwise healthy, 22 year old man starts passing dark urine; urinalysis shows dysmorphic erythrocytes. The hematuria subsides in 1 week, only to return four more times in the next year. In what part the glomerulus in this condition can you find electron dense deposits?

Answer 25

glomerular capillary basement membranes

Question 26

Ten days after recovering from a mild respiratory tract infection, an otherwise healthy, 22 year old man starts passing dark urine; urinalysis shows dysmorphic erythrocytes. The hematuria subsides in 1 week, only to return four more times in the next year. How many percent of patients with this condition will progress into ESRD?

Answer 26

40%

Question 27

A 38 year old woman with morbid obesity has a 2 week history of malaise is found to be hypertensive with peripheral pitting edema. Her serum creatinine is 2.5 mg/dL (nl<1.3), and a 24 hour urine has 3.7 g of protein (nephrotic range). Her antinuclear antibody titer is negative. She does not respond to corticosteroid therapy. What is your diagnosis?

Answer 27

Focal Segmental Glomerulosclerosis

Question 28

A 38 year old woman with morbid obesity has a 2 week history of malaise is found to be hypertensive with peripheral pitting edema. Her serum creatinine is 2.5 mg/dL (nl<1.3), and a 24 hour urine has 3.7 g of protein (nephrotic range). Her antinuclear antibody titer is negative. She does not respond to corticosteroid therapy. For this condition, what microscopic finding would aid in the diagnosis?

Answer 28

Focal mesangial proliferation

Question 29

A 38 year old woman with morbid obesity has a 2 week history of malaise is found to be hypertensive with peripheral pitting edema. Her serum creatinine is 2.5 mg/dL (nl<1.3), and a 24 hour urine has 3.7 g of protein (nephrotic range). Her antinuclear antibody titer is negative. She does not respond to corticosteroid therapy. The most common etiology of this disease:

Answer 29

Idiopathic

Question 30

A 38 year old woman with morbid obesity has a 2 week history of malaise is found to be hypertensive with peripheral pitting edema. Her serum creatinine is 2.5 mg/dL (nl<1.3), and a 24 hour urine has 3.7 g of protein (nephrotic range). Her antinuclear antibody titer is negative. She

Answer 30

50%