Urology & Nephrology Flashcards
A 57-year-old immigrant from Nigeria presented to the emergency department for sudden, severe pain and swelling in her lower extremity. She was at a rehabilitation hospital when her symptoms became apparent. The patient has a past medical history of obesity, diabetes, bipolar disorder, and tonic-clonic seizures. What histological feature is shown?
- A ) Crescent formation, rapidly progressive glomerulonephritis
- B ) Focal segmental glomerulosclerosis
- C ) Hypercellular, inflamed glomerulus - nephritic syndrome
- D ) Kimmelstiel-Wilson nodules
- E ) Membranous nephropathy
= D ) Kimmelstiel-Wilson nodules
Sclerosis of the mesangium with the formation of Kimmelstiel-Wilson nodules in patients with diabetes.
What are three locations where the ureters are at their narrowest and a stone is more likely to become stuck?
- A ) Major and minor calyces, uretopelvic junction, pelvic brim crossing round ligament (vas deferens)
- B ) Minor calyces, uretopelvic junction and ureterovesical junction
- C ) Minor calyces, uretopelvic junction, pelvic brim crossing round ligament (vas deferens)
- D ) Uretopelvic junction, pelvic brim crossing common iliac artery and ureterovesical junction
- E ) Uretopelvic junction, pelvic brim crossing uterine artery and ureterovesical junction
= D ) Uretopelvic junction, pelvic brim crossing common iliac artery and ureterovesical junction
Which organism can cause UTIs or a severe otitis externa in diabetic patients?
- A ) Campylobacter jejunii
- B ) Enterococcus faecalis
- C ) Escherichia coli
- D ) Group B Streptococcus
- E ) Haemophilus influenzae
- F ) Klebsiella pneumoniae
- G ) Neisseria meningitidis
- H ) Proteus mirabilis
- I ) Pseudomonas aeruginosa
- J ) Salmonella typhi
- K ) Staphylococcus aureus
- L ) Staphylococcus saprophyticus
= I ) Pseudomonas aeruginosa
Which organism(s) can colonise the female genital tract and cause UTI’s, or alternatively infect a neonate to cause neonatal pneumonia or meningitis?
- A ) Campylobacter jejunii
- B ) Enterococcus faecalis
- C ) Group B Streptococcus
- D ) Haemophilus influenzae
- E ) Klebsiella pneumoniae
- F ) Listeria monocytogenes
- G ) Neisseria meningitidis
- H ) Proteus mirabilis
- I ) Pseudomonas aeruginosa
- J ) Salmonella typhi
- K ) Staphylococcus aureus
- L ) Staphylococcus saprophyticus
= C ) Group B Streptococcus
Which encapsulated organism commonly causes UTIs in a hospital setting?
- A ) Campylobacter jejunii
- B ) Enterococcus faecalis
- C ) Escherichia coli
- D ) Group B Streptococcus
- E ) Haemophilus influenzae
- F ) Klebsiella pneumoniae
- G ) Neisseria meningitidis
- H ) Proteus mirabilis
- I ) Pseudomonas aeruginosa
- J ) Salmonella typhi
- K ) Staphylococcus aureus
- L ) Staphylococcus saprophyticus
= C ) Escherichia coli
Which of the following is an example of a carbonic anhydrase inhibitor?
- A ) Acetazolamide
- B ) Furosemide
- C ) Hydrochlorothiazide
- D ) Mannitol
- E ) Spironolactone
= A ) Acetazolamide
- A ) Dialysis
- B ) Intravenous (IV) prednisolone
- C ) Observation
- D ) Plasma exchange, prednisone, and cyclophosphamide
- E ) Renal transplant
= D ) Plasma exchange, prednisone, and cyclophosphamide
Which of the following is an example of an osmotic diuretic?
- A ) Amiloride
- B ) Furosemide
- C ) Hydrochlorothiazide
- D ) Mannitol
- E ) Spironolactone
= D ) Mannitol
A 10-year-old boy has experienced increasing malaise for the past 2 weeks.
O/E: he has periorbital edema. The child is afebrile.
Ix: laboratory findings show proteinuria on dipstick urinalysis, but no hematuria or glucosuria.
A renal biopsy is performed and electron microscopic examination shows the following:
He receives a course of corticosteroid therapy and improves.
What is the most likely diagnosis?
- A ) Focal segmental glomerulosclerosis
- B ) Goodpasture’s syndrome
- C ) Minimal change disease
- D ) Nodular glomerulosclerosis
- E ) Systemic lupus erythematosus
= C ) Minimal change disease
This immunofluorescence pattern is positive for IgG antibody and has a smooth, diffuse, linear pattern. It is characteristic of which disease?
- A ) Acute poststreptococcal glomerulonephritis
- B ) Anti-glomerular basement membrane (anti-GBM) disease
- C ) Diabetes and chronic kidney conditions
- D ) Glomerulonephritis
- E ) Idiopathic membranous nephropathy
= B ) Anti-glomerular basement membrane (anti-GBM) disease
This immunofluorescence pattern shows positivity with antibody to IgG and has a smooth, diffuse, linear pattern that is characteristic for deposition of glomerular basement membrane antibody with Goodpasture syndrome. Serologic testing for anti-GBM in patient serum is often positive.
Which sign or symptom is more likely to be prominent in nephrotic syndrome as compared to nephritic syndrome?
- A ) Fatigue
- B ) Haematuria
- C ) Hypertension
- D ) Periorbital oedema
- E ) Restless leg syndrome
= D ) Periorbital oedema
In nephrotic syndrome, gaps in podocytes allow a greater loss of protein; hypoalbuminaemia results in lower plasma oncotic pressure, leading to oedema. While some protein is lost in nephritic syndrome, the key pathological feature is disruption of basement membrane function and it commonly presents with haematuria.
What is the most common type of renal stone?
- A ) Calcium oxalate
- B ) Calcium phosphate
- C ) Cystine
- D ) Struvite
- E ) Uric acid
= A ) Calcium oxalate
Calcium oxalate accounts for around 85% of renal calculi. They are moderately radio-opaque on x-ray, but not as opaque as calcium phosphate stones, which have a composition similar to bone.
Which one of the following diseases is shown in this histological slide?
- A ) Amyloidosis
- B ) Focal segmental glomerulosclerosis
- C ) Goodpasture’s syndrome
- D ) Membranous glomerulonephritis
- E ) Minimal change disease
- F ) Nodular glomerulosclerosis
= B ) Focal segmental glomerulosclerosis
A 4-year-old boy presents with haematuria, abdominal pain and a purpuric rash over the legs and buttocks. He was been seen by his primary care physician 3 days earlier for a sore throat. The most likely diagnosis is:
- A ) Henoch–Schönlein purpura (HSP)
- B ) Meningococcal rash
- C ) Renal tuberculosis
- D ) Urinary tract infection (UTI)
- E ) Wilms’ tumour
= A ) Henoch–Schönlein purpura (HSP)
HSP is the most common vasculitis of childhood. It is most commonly seen in children 2-8 years of age. In ~50% of cases, there is a history of a recent upper respiratory tract infection
A 35-year-old male presents with haematuria, which began 24 hours ago. He has a longstanding history of a dry cough. Basement membrane of the kidneys shows anti-glomerular basement membrane antibodies (anti-GBM). Which of the following is the most likely diagnosis?
- A ) Goodpasture syndrome
- B ) Granulomatosis with polyangiitis
- C ) Nephrotic syndrome
- D ) Systemic lupus erythematosus (SLE)
- E ) Urinary tract infection
= A ) Goodpasture syndrome
Which diuretic acts as an aldosterone antagonist?
- A ) Acetazolamide
- B ) Bendroflumethiazide
- C ) Furosemide
- D ) Mannitol
- E ) Spironolactone
= E ) Spironolactone
- *Spironolactone** - potassium-sparing diuretic
- *Furosemide** - loop diuretic
- *Acetazolamide** - carbonic anhydrase inhibitor
- *Mannitol** - osmotic diuretic
- *Bendroflumethiazide** - thiazide diuretic
Renal tubular disorders are a heterogeneous group of diseases that involve dysfunctions of transporters and channels in the renal tubular system. Primary adrenal insufficiency (Addison disease causes which type of renal tubular disorders?
- A ) Type 1
- B ) Type 2
- C ) Type 3
- D ) Type 4
= D ) Type 4
- Aldosterone deficiency and/or resistance in the collecting duct and distal convoluted tubules → hyperkalemia and metabolic acidosis → inhibition of ammonia (NH3) synthesis in the proximal convoluted tubules → decreased urinary ammonium (NH4+) excretion
- Treatment
- Furosemide
- Mineralocorticoid replacement (fludrocortisone)
- Low-potassium diet
A patient presents with nephrotic syndrome. H&E silver staining of kidney biopsy shows a double contour to many basement membranes; the pathologist describes this as a ‘tram-tracking’ appearance. Which pathology is this indicative of?
- A ) Alport syndrome
- B ) Focal segmental glomerulosclerosis
- C ) IgA nephropathy
- D ) Membranoproliferative glomerulonephritis
- E ) Systemic amyloidosis
= D ) Membranoproliferative glomerulonephritis
What pathogen is the most common cause of urinary tract infections?
- A ) Escherichia coli
- B ) Klebsiella pneumoniae
- C ) Proteus mirabilis
- D ) Staphylococcus aureus
- E ) Staphylococcus saprophyticus
= A ) Escherichia coli
While they all potentially cause UTIs, E. coli is the most common overall. E. coli employs specialised adhesins (P fimbriae) to attach to urinary tract epithelial cells.
If S. aureus is present on microscopy of urine, consider if the urine is contaminated; it may have been present on the perineum and transferred into the sample. A repeat MSU may be necessary.
A 54-year-old female presents with generalized oedema particularly around the face and eyes. On urinalysis, her urine contains a high amount of protein. She is known to have rheumatoid arthritis and was started on gold injections 6 weeks previously.
Which diagnosis is most likely?
- A ) Acute kidney injury
- B ) Amyloidosis
- C ) Haemolytic uraemic syndrome (HUS)
- D ) Nephritic syndrome
- E ) Nephrotic syndrome
= E ) Nephrotic syndrome
What is the most common cause of nephrotic syndrome in white populations and is associated with hepatitis B and C?
- A ) Focal segmental glomerulosclerosis
- B ) IgA nephropathy
- C ) Membranoproliferative glomerulonephritis
- D ) Membranous nephropathy
- E ) Systemic amyloidosis
= D ) Membranous nephropathy
What cause of glomerulonephritis is distinguished by the presence of apple-green birefringence when a congo red stain is placed under polarised light?
- A ) Amyloidosis
- B ) Goodpasture’s syndrome
- C ) IgA nephropathy
- D ) Minimal change disease
- E ) Post-streptococcal glomerulonephritis
= A ) Amyloidosis
The congo red compound is used for staining in amyloidosis.
Which of the following is an example of a loop diuretic?
- A ) Amiloride
- B ) Furosemide
- C ) Hydrochorothiazide
- D ) Mannitol
- E ) Spironolactone
= B ) Furosemide
Which of the following pathologies is the least likely explanation for an enlarged kidney?
- A ) Diabetic nephropathy
- B ) Hydronephrosis
- C ) Polycystic kidney disease
- D ) Renal amyloidosis
- E ) Renal cell carcinoma
= A ) Diabetic nephropathy
Diabetic nephropathy is not a cause of enlarged kidneys but is one of the most common causes of chronic kidney disease, often leading to small shrunken kidneys. Amyloidosis is classically associated with moderately enlarged kidneys, rarely to the degree that they are palpable. Hydronephrosis occasionally causes a kidney to be palpably enlarged. A renal tumour can massively enlarge one kidney; bilateral enlargement is most likely PKD.
Which renal stone is completely radiolucent on an X-ray film?
- A ) Calcium oxalate
- B ) Calcium phosphate
- C ) Mixed calcium oxalate and calcium phosphate
- D ) Struvite
- E ) Uric acid
= E ) Uric acid
Cystine calculi are only faintly radiodense, while uric acid stones are usually entirely radiolucent.
What is the most common cause of urinary tract infections (UTIs)?
Answer: Escherichia coli
Select the most appropriate diagnosis:
A 72-year-old male presents with weakness and weight loss:
Sodium 115 (135–145mmol/L)
Potassium 3.5 (3.5–5mmol/L)
Urea 3.2 (2.5–6.7mmol/L)
Creatinine 72 (70–150μmol/L)
Urine osmolality 140 mOsm/kg (<100 mOsm/kg)
- A ) Acute renal failure
- B ) Addison’s disease
- C ) Chronic renal failure
- D ) Conn’s syndrome
- E ) Cushing’s disease
- F ) Diabetes insipidus
- G ) Normal results
- H ) SIADH
= H ) SIADH
What finding is highly specific for chronic renal failure?
- A ) Anaemia
- B ) Broad casts in urinalysis
- C ) Hyaline casts
- D ) Hypocalcemia
- E ) Proteinuria
= B ) Broad casts in urinalysis
The finding of broad casts reflects compensatory dilatation of surviving nephrons, and is specific to end stage chronic renal failure. Urinary stasis leads to the formation of casts in the dilated collecting ducts, and can be up to six times larger than other casts.
Hyaline casts are a nonspecific finding. Proteinuria can be present in various stages of renal disease. Anaemia and hypocalcemia can be present in acute renal failure and are usually multifactorial.
In a patient with minimal change disease which one of the filtration forces at the glomerulus changes?
- A ) Bowman hydrostatic pressure
- B ) Bowman oncotic pressure
- C ) None; all pressures remain at normal levels
- D ) Plasma hydrostatic pressure
- E ) Plasma oncotic pressure
= B ) Bowman oncotic pressure
In minimal change disease, the glomerular barrier fails to retain albumin in the capillary, and albumin enters Bowman’s space.
Which of the following serologic findings is associated with linear staining of the glomerulus on immunofluorescence?
- A ) ANCA associated renal disease
- B ) Anti-GBM antibody
- C ) Low complement immune complex glomerulonephritis
- D ) Membranoproliferative glomerulonephritis
- E ) Systemic lupus erythematosus
= B ) Anti-GBM antibody
As per this image, the walls of the capillaries are well marked by a continuous green line. This is the ‘linear staining’, seen in anti-GBM disease and sometimes diabetic nephropathy.
- A ) Adrenal insufficiency
- B ) Furosemide-induced hyponatremia
- C ) Hydrochlorothiazide-induced hyponatremia
- D ) Syndrome of inappropriate antidiuretic hormone (SIADH)
- E ) Thyroid disease
= C ) Hydrochlorothiazide-induced hyponatremia
Which of the following diseases is shown in this histological slide?
- A ) Amyloidosis
- B ) Focal segmental glomerulosclerosis
- C ) Goodpasture’s syndrome
- D ) Membranous glomerulonephritis
- E ) Minimal change disease
- F ) Nodular glomerulosclerosis
= D ) Membranous glomerulonephritis
The characteristic changes in MGN are observed in the glomerular capillary walls. The glomerular architecture is preserved and the capillary walls appear thickened. The cellularity is usually not increased, and if present it suggests a secondary MGN; and the capillary lumina are ample.
Which of the following diseases is shown in this histological slide?
- A ) Amyloidosis
- B ) Focal segmental glomerulosclerosis
- C ) Goodpasture’s syndrome
- D ) Membranoproliferative glomerulonephritis
- E ) Membranous glomerulonephritis
- F ) Minimal change disease
= D) Membranoproliferative glomerulonephritis
There is a diffuse increase of tuft cellularity; the increase in cellularity is predominantly in the mesangial region, sometimes associated to abundant monocytes and neutrophils. “Lobulation” of the tuft can be prominent and capillary walls are thickened with decrease in capillary lumens.
Leukocytes and white cell casts, as well as urine eosinophils, are typically seen in which pathology?
- A ) Aminoglycoside nephrotoxicity
- B ) Nafcillin-induced renal insufficiency
- C ) Radiocontrast nephropathy
- D ) Renal calculi
- E ) Rhabdomyolysis
= B ) Nafcillin-induced renal insufficiency
Which of the following diseases is shown in this histological slide?
- A ) Amyloidosis
- B ) Focal segmental glomerulosclerosis
- C ) Goodpasture’s syndrome
- D ) Membranous glomerulonephritis
- E ) Minimal change disease
- F ) Nodular glomerulosclerosis
= A ) Amyloidosis
- In amyloidosis, amorphous pink deposits of amyloid may be found in and around arteries; in interstitium or in glomeruli, as seen here with this H&E stain.
- A Congo red stain would demonstrate the pink material to be amyloid and is the most definitive stain for the diagnosis of amyloidosis. When the Congo red stain is viewed under polarized light (as per the image below; Holmes, 2018), the amyloid proteins demonstrate apple-green birefringence.
- Such collections of amyloid add to renal bulk but diminish renal function.
A 60-year-old woman presents to the emergency room with fever, chills, sudden flank pain, and gross hematuria. She has a history of recurrent urinary tract infections. Urinalysis reveals pyuria, hematuria, proteinuria, and dead tissue. An intravenous urography is obtained, revealing a ring sign. She is immediately given hydration and appropriate antibiotics.
- A ) Acute interstitial nephritis
- B ) Chronic renal failure
- C ) Fanconi syndrome
- D ) Hydronephrosis
- E ) Pyelonephritis
- F ) Renal papillary necrosis
- G ) Renal tubular acidosis
= F ) Renal papillary necrosis
A 65-year-old man presents to urgent care with a sudden-onset of fever and rash. His review of systems is negative. He was recently started on omeprazole for acid reflux approximately 2 weeks ago. Routine laboratory tests reveal a serum creatinine of 3.5 mg/dL and eosinophilia. Urine studies showed white blood cell casts.
What is the likely diagnosis?
- A ) Acute interstitial nephritis
- B ) Chronic renal failure
- C ) Fanconi syndrome
- D ) Hydronephrosis
- E ) Pyelonephritis
- F ) Renal papillary necrosis
- G ) Renal tubular acidosis
= A ) Acute interstitial nephritis
Answer: Option 8 is correct
Answer: Option 9 is correct
- Thick glomerular basement membrane on H&E, often with ‘tram-track’ appearance
- Due to immune complex deposition (granular IF)
- Divided into two types based on the location of deposits
- Poor response to steroids; progresses to chronic renal failure
Answer: Option 6 is correct
= Option 1
This immunofluorescence micrograph of a glomerulus demonstrates positivity with antibody to fibrinogen. With a rapidly progressive GN, the glomerular damage is so severe that fibrinogen leaks into Bowman’s space, leading to proliferation of the epithelial cells and formation of the bright crescent shown here.
Which image correctly represents the clinical features described below?
- Most common cause of nephrotic syndrome in Hispanics and African Americans
- May be associated with HIV, heroin use, and sickle cell disease
- No immune complex deposits; negative IF
- Poor response to steroids; commonly progresses to chronic renal failure
= Answer: Option 3 is correct
This is focal segmental glomerulosclerosis (FSGS). An area of collagenous sclerosis runs across the middle of this glomerulus. As the name implies, only some (focal) glomeruli are affected and just part (a segment) of the affected glomerulus is sclerosed. In contrast to minimal change disease, patients with FSGS are more likely to have non-selective proteinuria, haematuria, poor response to corticosteroid therapy, and progression to chronic renal failure.
Which image correctly represents the clinical features described below?
- Most common cause of nephrotic syndrome in Caucasian adults
- Usually idiopathic; may be associated with hepatitis B or C, solid tumours, SLE, or drugs (e.g., NSAIDs and penicillamine)
= Answer: Option 1 is correct
Membranous Nephropathy is shown by image 1.
Which immunofluorescence microscopy image below shows the pathological changes seen in post-infectious glomerulonephritis?
= Answer: Option 2
Post-infectious glomerulonephritis is immunologically mediated, and the immune deposits are widely distributed within the capillary loops. These deposits are seen with as a granular, bumpy pattern of bright green fluorescence within the capillaries, because of the focal nature of the immune complex deposition process.
Which immunofluorescence microscopy shows the pathological changes seen in IgA nephropathy?
Answer: Option 4
This immunofluorescence pattern demonstrates positivity with antibody to IgA. Note that the pattern is that of mesangial deposition within the glomerulus.
Which immunofluorescence microscopy image shows the pathological changes seen in membranous nephropathy?
Answer: Option 3
Membranous nephropathy is an immunologically mediated disease in which deposits of mainly IgG and complement collect in the basement membrane and appear in a diffuse granular pattern by immunofluorescence, as seen here. Membranous nephropathy can be secondary to an underlying malignancy, infection, drug ingestion, or SLE.
Answer: Option 7 is correct
Pseudogout = Rhomboid-shaped crystals with weakly positive birefringence under polarized light.
