Step1_Renal

Question 1

Sclerosis and hyalinosis in portions of some glomeruli

Answer 1

Focal segmental glomerulosclerosis (FSGS)

Question 2

Subepithelial electron-dense “bumps and humps”

Answer 2

Post-streptococcal glomerulonephritis (PSGN) typically arises 1-4 weeks after infection with a nephritogenic, M protein virulence factor-containing, Group A β-hemolytic streptococcal infection (often impetigo or pharyngitis).

Question 3

Mesangial cell proliferation

Answer 3

IgA nephropathy

Question 4

“Tram-track” basement membrane

Answer 4

Membranoproliferative glomerulonephritis (MPGN), TYPE 1

Question 5

“Splitting” of the lamina densa

Answer 5

Alport syndrome

Question 6

Linear IgG and C3 deposits

Answer 6

Goodpasture syndrome is a type II hypersensitivity reaction in which IgG anti-GBM (glomerular basement membrane) antibodies mediate damage to the glomeruli and pulmonary alveoli.

The inciting antigen in Goodpasture syndrome is the α3 chain of type IV collagen in the GBM.

Question 7

Crescents in Bowman’s space = ?

Answer 7

Rapidly progressive glomerulonephritis (RPGN) is a nephritic syndrome characterized by rapid loss of renal function.

Question 8

Normal glomeruli with lipid-laden tubular cells = ?

Answer 8

Minimal change disease (MCD, aka lipoid nephrosis)

Question 9

Kimmelstiel-Wilson nodules = ?

Answer 9

diabetic nephropathy

Question 10

Electron microscopy of a renal biopsy shows irregular thinning of the GBM with splitting/lamination of the lamina densa, giving the GBM a unique “basketweave” appearance = ?

Answer 10

Alport syndrome

Question 11

EM showing Dense intramembranous deposits = ?

Answer 11

Membranoproliferative glomerulonephritis (MPGN) , TYPE 2

Question 12

Immunofluorescence microscopy showing IgA-based immunocomplex deposits in the mesangium = ?

Answer 12

IgA nephropathy

Question 13

Electron microscopy showing diffuse effacement of foot processes in both sclerotic and non-sclerotic areas = ?

Answer 13

Focal segmental glomerulosclerosis (FSGS)

Question 14

Electron microscopy showing diffuse effacement of foot processes in both sclerotic and non-sclerotic areas = ?

Answer 14

Focal segmental glomerulosclerosis (FSGS)

Question 15

subepithelial deposition of immune complexes = ?

Answer 15

Membranous nephropathy

Question 16

Kidney biopsy showing a “spike and dome” pattern on electron microscopy = ?

Answer 16

Membranous nephropathy

Question 17

Serum levels of C3 decrease, while C1 and C4 levels are normal = ?

Answer 17

Post-streptococcal glomerulonephritis (PSGN)

Question 18

____________ syndrome classically presents with hemoptysis, followed by hematuria and acute renal failure. The pulmonary symptoms classically precede renal symptoms by days to weeks.

Answer 18

syndrome classically presents with hemoptysis, followed by hematuria andacute renal failure. The pulmonary symptoms classically precede renal symptoms by days to weeks.

The renal symptoms of Goodpasture syndrome manifests as a nephritic syndrome, with hematuria and RBC casts in the urine.

Question 19

A renal biopsy that shows crescentic glomerulonephritis and linear deposition of IgG along the glomerular capillaries on immunofluorescent microscopy = ?

Answer 19

Goodpasture syndrome

Question 20

Patients with ESRD on chronic maintenance hemodialysis are at increased risk for developing what?

Answer 20

acquired renal cystic disease.

Individuals with acquired renal cystic disease are at increased risk of developing renal cell carcinoma.

Question 21

Rhabdomyolysis is a syndrome that is characterized by muscle necrosis, resulting in muscle cell membrane damage and release of intracellular contents into the circulation.

What type of casts would you find in the urine?

Answer 21

Granular “muddy brown” casts

Question 22

_____ casts are composed of Tamm-Horsfall protein, a mucoprotein normally secreted from tubular epithelial cells.

Answer 22

Hyaline

Can be normal, or indicated low urine flow, or acidic environment.

Question 23

White blood cell (WBC) casts are highly suggestive of what?

Answer 23

acute pyelonephritis

they can also indicate other inflammatory processes such as tubulointerstitial inflammation or transplant rejection following a renal transplant.

Question 24

_______ casts can be found in patients with chronic end-stage renal disease.

Answer 24

Waxy Casts

Question 25

__________ casts are a pathological finding that are indicative of glomerular damage.

Answer 25

Red blood cell (RBC) casts.

differential diagnosis for the presence of RBC casts includes glomerulonephritis, ischemia, or malignant hypertension.

Question 26

What is the inciting antigen in Goodpasture syndrome?

Answer 26

The inciting antigen in Goodpasture syndrome is the α3 chain of type IV collagen in the GBM.

Question 27

What two disease process show showpodocyte effacementon EM?

Answer 27

Both minimal change diseaseand focal segmental glomerulosclerosis (FSGS)showpodocyte effacementon EM.

Question 28

Goodpasture syndrome can lead to what pulmonary disease?

Answer 28

Autoantibody damage to pulmonary alveoli gives rise to a necrotizing hemorrhagic interstitial pneumonitis.

Question 29

What HLA subtype is associated with Goodpasture Syndrome?

Answer 29

HLA-DR2

Question 30

Accumulation of proteinaceous material resulting in a thyroid-like appearance == ?

Answer 30

chronic pyelonephritis, resulting from recurrent episodes of acute pyelonephritis and urinary tract infections.

Question 31

Urinalysis demonstrates deposition of hexagonal cystine crystals, what is the most likely pathology?

Answer 31

patient with cystinuria and acidic urine.

deposition of hexagonal cystine crystals, most likely resulting in the formation of a cystine stone in the ureter.

Question 32

________ is an autosomal recessive defect in renal reabsorption of amino acids (COLA: cystine, ornithine, lysine, and arginine).

Answer 32

Cystinuria

Question 33

Urinalysis demonstrates deposition of hexagonal cystine crystals, what is the best Tx?

Answer 33

Acetazolamide is a carbonic anhydrase inhibitor with mechanism of action in the proximal renal tubule.

Inhibition of carbonic anhydrase also alkalinizes the urine.

All of these treatments aim to keep pH at 7.5 to 8 in order to solubilize cystine and facilitate diuresis.

Question 34

What renal pathology presents with massive proteinuria and S/Sx of nephrotic syndrome, however renal function is usually maintained and there is usually no hematuria or hypertension.

Answer 34

Minimal change disease

Question 35

___________ typically occurs shortly after an upper respiratory infection. Patients may have:

• hematuria
• flank pain
• low-grade fever

Answer 35

IgA nephropathy

IgA immune complexes deposit in the mesangial cells of the kidneys, leading to damage of the glomeruli and nephritic range hematuria.