Path 20A Flashcards

A renal biopsy is being interpreted in a patient with suspected primary glomerular disease. Which mechanism most commonly underlies glomerular diseases?

A) Toxic tubular injury

B) Immunologic injury

C) Viral epithelial lysis

D) Obstructive pressure injury

Which mechanism best fits tubular/interstitial diseases?

A) Toxic or infectious injury

B) Anti-GBM autoimmunity

C) Immune complex deposition

D) Podocyte slit diaphragm loss

A patient has elevated blood urea nitrogen and creatinine without further clinical description. Which term best describes this laboratory abnormality?

A) Uremia

B) Proteinuria

C) Azotemia

D) Nephrosis

A patient with elevated BUN and creatinine develops clinical signs from biochemical abnormalities of renal failure. Which term applies?

A) Azotemia

B) Uremia

C) Hematuria

D) Sclerosis

A patient has heavy proteinuria, edema, hyperlipidemia, and lipiduria. Which renal syndrome best fits this pattern?

A) Nephritic syndrome

B) Tubulointerstitial nephritis

C) Nephrotic syndrome

D) Rapidly progressive nephritis

A patient has hematuria, hypertension, azotemia, and sub-nephrotic proteinuria after glomerular inflammation. Which syndrome is most likely?

A) Nephrotic syndrome

B) Nephritic syndrome

C) Fanconi syndrome

D) Uremic syndrome

Which pairing correctly distinguishes nephrotic from nephritic syndrome?

A) Nephrotic-hematuria; nephritic-massive proteinuria

B) Nephrotic-edema/proteinuria; nephritic-hematuria/azotemia

C) Nephrotic-hypertension only; nephritic-lipiduria only

D) Nephrotic-crescents; nephritic-PLA2R antibodies

The glomerular basement membrane is being studied for its major collagen composition. Which collagen type predominates?

A) Type I

B) Type II

C) Type III

D) Type IV

A glomerular capillary wall is examined under electron microscopy. The visceral epithelial cells covering the basement membrane are called what?

A) Mesangial cells

B) Podocytes

C) Endothelial fenestrations

D) Macula densa

Which glomerular cell type is mainly responsible for laying down matrix and collagen in the kidney?

A) Podocyte

B) Endothelial cell

C) Mesangial cell

D) Parietal epithelial cell

Mesangial cells are mesenchymal-origin cells in the glomerulus that function most like which cell type?

A) Pericytes

B) Osteoblasts

C) Hepatocytes

D) Fibroblasts

Which glomerular cell is most important for maintaining the filtration barrier and preventing proteinuria?

A) Mesangial cell

B) Podocyte

C) Macula densa cell

D) Juxtaglomerular cell

A mutation disrupts an important slit diaphragm protein with Ig domains and CD2-associated proteins. Which protein is affected?

A) Nephrin

B) Collagen IV

C) PLA2R

D) C5a

Nephrin is most directly associated with which glomerular structure?

A) Mesangial matrix

B) Endothelial fenestrae

C) Slit diaphragm

D) Bowman capsule

A pathologist wants to visualize thickening of the glomerular basement membrane. Which stain is appropriate?

A) Congo red

B) Ziehl-Neelsen

C) Oil red O

D) Periodic acid-Schiff

Chronic glomerular damage to endothelium or capillaries produces glassy proteinaceous vascular change. Which term describes this end result?

A) Sclerosis

B) Hyalinosis

C) Crescent formation

D) Amyloidosis

Damage to mesangial areas causes deposition of collagenous matrix within the glomerulus. Which term describes this process?

A) Sclerosis

B) Hyalinosis

C) Azotemia

D) Uremia

Which comparison best distinguishes hyalinosis from sclerosis in chronic glomerular injury?

A) Hyalinosis-endothelium; sclerosis-mesangium

B) Hyalinosis-mesangium; sclerosis-podocytes

C) Hyalinosis-immune complexes; sclerosis-crescents

D) Hyalinosis-nephrin; sclerosis-PLA2R

A patient develops new massive proteinuria after injury to a specific glomerular cell type. Which cell was most likely damaged?

A) Podocytes

B) Mesangial cells

C) Macula densa cells

D) Collecting duct cells

Most glomerular injury is with complement activation rather than direct toxic damage. Which mechanism is most typical?

A) Antibody-mediated injury

B) Heavy metal toxicity

C) Bacterial tubular invasion

D) Ischemic papillary necrosis

Deposited antigen-antibody complexes along the glomerular membrane produce which immunofluorescence pattern?

A) Linear

B) Granular

C) Negative

D) Cytoplasmic

Immune complex glomerulonephritis recruits leukocytes when immune deposits bind which leukocyte receptor type?

A) T-cell receptor

B) Fc receptor

C) TLR4 receptor

D) V2 receptor

A glomerulonephritis biopsy shows granular immune deposits. Which mechanism best explains the pattern?

A) Autoantibodies bind GBM uniformly

B) Complexes deposit discontinuously

C) Toxins injure tubules directly

D) Podocytes lose nephrin uniformly

During glomerulonephritis, neutrophils and monocytes are recruited by a chemotactic complement fragment. Which complement protein is responsible

A) C3b

B) C1q

C) C5a

D) C9

C5a contributes to glomerular inflammation primarily through which function?

A) Chemotaxis for phagocytes

B) Collagen IV synthesis

C) Podocyte slit formation

D) Urea transport activation

Neutrophils recruited into inflamed glomeruli worsen injury mainly by releasing which damaging products?

A) Antibodies

B) Proteases

C) Nephrin

D) PLA2R

Monocytes recruited during glomerulonephritis can differentiate into which inflammatory cells?

A) Plasma cells

B) Podocytes

C) Macrophages

D) Mesangial cells

A kidney biopsy shows smooth linear immunofluorescence along the glomerular basement membrane. Which immune mechanism best explains this finding?

A) Circulating immune complexes

B) Anti-GBM autoantibodies

C) Direct bacterial invasion

D) Tubular toxin injury

Which pairing correctly matches immunofluorescence pattern with mechanism?

A) Granular-immune complexes; linear-anti-GBM

B) Granular-anti-GBM; linear-toxins

C) Granular-podocyte injury; linear-uremia

D) Granular-C5a; linear-nephrin loss

A child develops hematuria and edema 1-2 weeks after pharyngitis. Which exogenous infection most commonly causes nephritic syndrome?

A) Staphylococcus aureus

B) Streptococcus

C) Escherichia coli

D) Pseudomonas

A streptococcal infection triggers nephritic syndrome by an immune reaction involving which exotoxin in these notes?

A) SpeB exotoxin

B) Shiga toxin

C) TSST-1

D) Exotoxin A

A child develops malaise, fever, nausea, and hematuria 2 weeks after infection. Which diagnosis is most likely?

A) Minimal change disease

B) Postinfectious glomerulonephritis

C) Membranous nephropathy

D) Diabetic nephropathy

An adult develops nephritic syndrome with hypertension, orbital edema, and elevated BUN after infection. Which diagnosis best fits?

A) Postinfectious glomerulonephritis

B) Primary membranous nephropathy

C) Minimal change disease

D) Acute tubular necrosis

Which electron microscopy finding is classically associated with postinfectious glomerulonephritis?

A) Spike-and-dome deposits

B) Humped deposits

C) Basket-weave GBM

D) Amyloid fibrils

Histology of postinfectious glomerulonephritis commonly shows which glomerular pattern?

A) Hypercellularity

B) Nodular amyloid

C) Tubular casts only

D) Papillary necrosis

Which combination best matches postinfectious glomerulonephritis?

A) Streptococcus, humped deposits, hypercellularity

B) PLA2R, spike deposits, nephrotic syndrome

C) ANCA, linear deposits, podocyte effacement

D) Ethylene glycol, oxalate, tubular necrosis

Rapidly progressive glomerulonephritis is identified histologically by which hallmark lesion?

A) Kimmelstiel-Wilson nodules

B) Crescent shapes

C) Fatty casts

D) Zebra bodies

A patient has rapidly progressive renal failure, and biopsy shows crescents in Bowman space. Which syndrome is most likely?

A) Rapidly progressive glomerulonephritis.

B) Nephrotic syndrome

C) Uremic pericarditis

D) Chronic pyelonephritis

A patient presents with pulmonary hemorrhage and rapidly worsening renal failure. Which diagnosis is most likely?

A) Poststreptococcal GN

B) Goodpasture syndrome

C) Primary membranous nephropathy

D) Minimal change disease

Goodpasture syndrome causes lung and kidney disease through which mechanism?

A) Anti-GBM antibody deposits

B) PLA2R immune complexes

C) Streptococcal SpeB toxin

D) Toxic tubular infection

A kidney biopsy in Goodpasture syndrome is expected to show which major histologic feature in severe cases?

A) Crescent shapes

B) Fish-mouth scarring

C) Myxomatous degeneration

D) Humped subepithelial deposits

Most patients with rapidly progressive crescentic glomerulonephritis have which antibody type?

A) ANA

B) ANCA

C) Anti-dsDNA only

D) Anti-CCP

Membranous nephropathy is characterized by deposits of which substance on the glomerular basement membrane?

A) Immunoglobulins

B) Uric acid

C) Hemosiderin

D) Calcium phosphate

Primary membranous nephropathy is caused by autoantibodies against which podocyte-associated receptor?

A) Nephrin

B) Phospholipase A2 receptor

C) Fc receptor

D) C5a

Autoantibodies against phospholipase A2 receptor cause complement activation in which disease?

A) Primary membranous nephropathy

B) Postinfectious glomerulonephritis

C) Goodpasture syndrome

D) Diabetic sclerosis

Which pairing correctly distinguishes primary membranous nephropathy from Goodpasture syndrome?

A) Membranous-PLA2R; Goodpasture-anti-GBM

B) Membranous-ANCA; Goodpasture-PLA2R

C) Membranous-SpeB; Goodpasture-nephrin

D) Membranous-C5a; Goodpasture-streptococcus

Which sequence best explains immune complex glomerulonephritis inflammation?

A) Granular deposits bind Fc receptors

B) Linear toxins bind V2 receptors

C) Podocyte injury blocks complement

D) Mesangial cells release ADH

A patient has nephritic syndrome 2 weeks after streptococcal infection, granular deposits, low complement activation, and humped deposits. Which diagnosis fits best?

A) Postinfectious glomerulonephritis

B) Primary membranous nephropathy

C) Anti-GBM disease

D) Diabetic nephropathy

Which answer best links glomerular cell type to function?

A) Podocytes-barrier; mesangial cells-matrix

B) Podocytes-renin; mesangial cells-ADH

C) Podocytes-collagen I; mesangial cells-nephrin

D) Podocytes-urea; mesangial cells-hemoglobin

A patient with primary membranous nephropathy has subepithelial immune deposits along the glomerular basement membrane. Which immunoglobulin subclass is typically deposited?

A) IgA1

B) IgM

C) IgG4

D) IgE

Complement activation in membranous nephropathy can injure podocytes through the membrane attack complex. Which proteins form this complex?

A) C1q-C4b

B) C3a-C5a

C) C2a-C4a

D) C5b-C9

A child develops massive proteinuria without hematuria or hypertension. Biopsy appears normal by light microscopy, but electron microscopy shows diffuse foot process effacement. Which diagnosis is most likely?

A) FSGS

B) Minimal change disease

C) Membranous nephropathy

D) Berger disease

A child has nephrotic syndrome with selective albuminuria, normal blood pressure, and no hematuria. Which treatment is most likely effective?

A) ACE inhibitors

B) Plasmapheresis

C) Cyclophosphamide

D) Corticosteroids

Which feature best distinguishes minimal change disease from membranous nephropathy?

A) No immune deposits

B) Linear anti-GBM staining

C) Mesangial IgA deposits

D) Tram-track GBM

Which immune-related association can contribute to minimal change disease pathogenesis?

A) T-cell dysfunction

B) Anti-GBM antibodies

C) IgA glycosylation defects

D) C3 nephritic factor

Minimal change disease has a complex immune etiology involving HLA haplotypes, immune triggers, and which malignancy association?

A) Renal cell carcinoma

B) Hodgkin lymphoma

C) Colon adenocarcinoma

D) Hepatocellular carcinoma

Compared with children, minimal change disease in adults is less common and generally has what prognosis?

A) Better prognosis

B) Identical prognosis

C) Worse prognosis

D) Always fatal

Which clinical pattern best supports minimal change disease in a child?

A) Hematuria, crescents, pulmonary hemorrhage

B) Selective albuminuria, no hypertension

C) IgA deposits, recurrent hematuria

D) Tram tracks, hepatitis infection

A nephrotic child responds well to corticosteroids and has a good long-term prognosis. Which diagnosis best fits this response pattern?

A) Minimal change disease

B) FSGS

C) Type I MPGN

D) Alport syndrome

Which nephrotic syndrome is the most common type in adults in the United States?

A) Membranous nephropathy

B) Minimal change disease

C) Focal segmental glomerulosclerosis

D) Dense deposit disease

A patient with adult nephrotic syndrome has focal lesions affecting only segments of some glomeruli. Which diagnosis is most likely?

A) Minimal change disease

B) Berger disease

C) Alport syndrome

D) Focal segmental glomerulosclerosis

Focal segmental glomerulosclerosisis characterized by focal disruption and detachment of which glomerular cell type?

A) Podocytes

B) Parietal cells

C) Macula densa cells

D) Collecting duct cells

Which inflammatory mediator is responsible for fibrosis in focal segmental glomerulosclerosis?

A) IL-6

B) TGF-β

C) TNF-α

D) IFN-γ

A patient with FSGS asks whether this disease usually responds well to corticosteroids. Which answer is most accurate?

A) Yes, always curative

B) Only in children

C) No, poor response

D) Only with IgA deposits

Which prognosis pattern best fits focal segmental glomerulosclerosis?

A) Benign steroid-responsive childhood disease

B) No hematuria and full recovery

C) Mild disease without ESRD risk

D) Worse prognosis with ESRD progression

Compared with minimal change disease, focal segmental glomerulosclerosis is more associated with which finding?

A) More hematuria

B) No podocyte injury

C) Better steroid response

D) Normal electron microscopy

Does focal segmental glomerulosclerosis show podocytic foot process effacement?

A) No, immune deposits only

B) Yes, effacement occurs

C) Only in Alport syndrome

D) Only after steroids

Which combination best describes focal segmental glomerulosclerosis pathology?

A) Linear GBM staining, crescents

B) Humps, hypercellularity, low complement

C) Focal podocyte lesions, mesangial sclerosis

D) IgA deposits, glycosylation defects

A patient with HIV-associated nephropathy has a high likelihood of developing which focal segmental glomerulosclerosis variant?

A) Tip lesion variant

B) Perihilar variant

C) Collapsing variant

D) Cellular crescent variant

Which infection is associated with high frequencies of collapsing focal segmental glomerulosclerosis?

A) Hepatitis A

B) HIV

C) EBV

D) Parvovirus B19

A kidney biopsy shows IgG and complement deposited in the mesangial matrix in a nephritic syndrome. Which diagnosis is suggested?

A) Minimal change disease

B) Membranoproliferative GN

C) Alport syndrome

D) Primary membranous nephropathy

A biopsy shows subendothelial electron-dense deposits with duplication of the glomerular basement membrane. Which MPGN subtype is most likely?

A) Type II Membranoproliferative GN

B) Type I Membranoproliferative GN

C) Minimal change disease

D) Berger disease

In type II membranoproliferative glomerulonephritis, which deposit predominates?

A) IgG4

B) IgA

C) Albumin

D) C3 proteins

Type II membranoproliferative glomerulonephritis is also known by which name

A) Berger disease

B) Dense deposit disease

C) Minimal change disease

D) Goodpasture disease

Which MPGN subtype is characterized by excess complement pathway activation?

A) Type I MPGN

B) Type II MPGN

C) Minimal change disease

D) Primary membranous nephropathy

Type II MPGN has dense deposits located primarily in which glomerular compartment according to these notes?

A) Intramembranous GBM

B) Subepithelial space

C) Mesangial stalk only

D) Bowman capsule

Secondary membranoproliferative glomerulonephritis arises from which viral infections?

A) HIV and EBV

B) HSV and VZV

C) Hepatitis B and C

D) CMV and parvovirus

A patient with chronic hepatitis C develops nephritic-nephrotic glomerular disease with tram-track basement membranes. Which diagnosis is most likely?

A) Type I MPGN

B) Minimal change disease

C) Alport syndrome

D) Goodpasture syndrome

Which pairing correctly distinguishes MPGN type I from type II?

A) Type I-subendothelial; type II-C3 dense deposits

B) Type I-anti-GBM; type II-IgA deposits

C) Type I-foot effacement; type II-IgG4 deposits

D) Type I-Hodgkin; type II-albuminuria

A young patient has recurrent hematuria and prominent IgA deposits in the mesangial region. Which glomerular disorder is most likely?

A) Alport syndrome

B) Berger disease

C) Membranous nephropathy

D) Minimal change disease

Defects in which process are involved in the pathogenesis of Berger disease?

A) Collagen IV synthesis

B) IgA glycosylation

C) Podocyte titin truncation

D) Albumin hepatic synthesis

A hereditary nephritic syndrome is caused by mutations affecting type IV collagen. Which diagnosis is most likely?

A) Alport syndrome

B) FSGS

C) Membranous nephropathy

D) Dense deposit disease

Which syndrome-disease category pairing is correct for Alport syndrome?

A) Hereditary nephritic syndrome

B) Acquired nephrotic syndrome

C) Toxic tubular syndrome

D) Infectious interstitial syndrome

Which pairing correctly matches glomerular disease with immune deposit type?

A) Membranous-IgG4; Berger-IgA

B) Membranous-IgA; Berger-IgG4

C) MPGN II-IgE; Berger-C5b

D) Alport-IgG; FSGS-IgA

Which pairing correctly matches MPGN subtype with trigger or mechanism?

A) Type I-HBV/HCV; type II-complement activation

B) Type I-Hodgkin; type II-albuminuria

C) Type I-collagen IV; type II-IgA

D) Type I-HIV; type II-steroid response

A patient has SLE with rising creatinine, hypertension, and proteinuria. Which glomerulopathy pattern is most likely implied?

A) Membranous type

B) Minimal change type

C) Alport type

D) Berger type

Which complement complex directly damages cells at the end of the complement cascade?

A) C3 convertase

B) C5 convertase

C) C5b-C9 membrane attack complex

D) C1q immune complex

A boy has hereditary nephritic syndrome with hematuria, sensorineural hearing loss, ocular abnormalities, and a basket-weave glomerular basement membrane on electron microscopy. Which diagnosis best fits?

A) Berger disease

B) Alport syndrome

C) Type I MPGN

D) Minimal change disease

Which inheritance pattern best matches Alport syndrome in these notes?

A) X-linked dominant

B) Autosomal recessive

C) Mitochondrial

D) Autosomal dominant

A child develops palpable purpuric skin lesions, arthralgias, abdominal pain, intestinal bleeding, and renal abnormalities after an upper respiratory illness. Which syndrome is most likely?

A) Goodpasture syndrome

B) Minimal change disease

C) Henoch-Schonlein purpura

D) Type II MPGN

Henoch-Schonlein purpura is associated with Berger nephropathy because both involve which immune deposit pattern?

A) IgG4 subepithelial deposits

B) IgA deposits

C) Linear anti-GBM antibodies

D) C3 dense deposits

A renal biopsy from rapidly progressive glomerulonephritis shows crescent formation in Bowman space. Which material lines these crescents?

A) IgA

B) Amyloid

C) Hemosiderin

D) Fibrin

A patient has rapidly progressive renal failure with pulmonary hemorrhage due to antibodies against type IV collagen. Which lung-associated nephritic syndrome is implicated?

A) Henoch-Schonlein purpura

B) Goodpasture syndrome

C) Minimal change disease

D) Membranous nephropathy

A biopsy in rapidly progressive glomerulonephritis shows ruptured glomerular basement membranes with leakage of blood and leukocytes into Bowman space. Which pathologic process is this describing?

A) GBM rupture with necrosis

B) Mesangial IgA glycosylation

C) Subepithelial IgG4 deposition

D) Podocyte foot effacement