Path 20A Flashcards

Which broad mechanism most commonly underlies primary glomerular diseases? A) Toxic tubular injury

B) Immunologic injury

C) Viral epithelial lysis

D) Obstructive pressure injury

Which mechanism best fits most tubulointerstitial kidney diseases?

A) Toxic or infectious injury

B) Anti-GBM autoimmunity

C) Immune complex deposition

D) Podocyte slit diaphragm loss

Which sequence best represents the filtration barrier from blood to urine?

A) Podocyte → GBM → endothelium

B) Endothelium → GBM → podocyte

C) Mesangium → tubule → capsule

D) Bowman capsule → macula densa → GBM

A student asks why glomerular disease often causes either blood or protein in the urine. Which explanation is most accurate?

A) Damage changes filter selectivity

B) Ureters lose peristaltic function

C) Calyces overproduce urine protein

D) Tubules create red blood cells

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

A) Type I

B) Type II

C) Type III

D) Type IV

A biopsy stain is chosen to highlight thickening of the glomerular basement membrane and mesangial matrix. Which stain is most appropriate?

A) Congo red

B) Ziehl-Neelsen

C) Oil red O

D) Periodic acid-Schiff

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

A patient develops massive proteinuria after injury to a cell type that maintains the final barrier to protein filtration. Which glomerular cell was most likely damaged?

A) Podocyte

B) Mesangial cell

C) Macula densa cell

D) Collecting duct cell

A mutation disrupts the slit diaphragm between podocyte foot processes. Which protein is most directly affected?

A) Nephrin

B) Collagen IV

C) PLA2R

D) C5a

A child has nephrotic-range proteinuria due to podocyte foot process injury. Which normal podocyte function was most directly lost?

A) Maintaining protein barrier

B) Making erythropoietin

C) Sensing tubular sodium

D) Reabsorbing filtered glucose

Mesangial cells are mesenchymal-origin support cells in the glomerular tuft. They most closely resemble which cell type?

A) Pericytes

B) Osteoblasts

C) Hepatocytes

D) Fibroblasts

A biopsy shows expansion of the support matrix between glomerular capillary loops. Which glomerular component is most directly involved?

A) Mesangial matrix

B) Endothelial fenestrae

C) Slit diaphragm

D) Bowman capsule

Damage to mesangial areas causes collagen deposition and matrix expansion inside the glomerulus. Which term describes this scarring process?

A) Sclerosis

B) Hyalinosis

C) Azotemia

D) Uremia

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

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) Papillary necrosis

A patient loses large amounts of albumin in urine and develops edema. Which mechanism best explains the edema?

A) Reduced plasma oncotic pressure

B) Increased ureteral pressure

C) Increased erythropoietin synthesis

D) Reduced tubular ammonium production

A nephrotic patient develops hyperlipidemia and lipiduria. Which process best explains this association?

A) Liver increases lipoprotein synthesis

B) RBC casts obstruct tubules

C) GBM rupture releases fibrin

D) Macula densa secretes renin

A nephritic patient has red blood cells in urine. What is the main reason hematuria occurs?

A) Inflamed capillary wall leaks blood

B) Podocytes secrete hemoglobin

C) Tubules make excess red cells

D) Albumin pulls cells into urine

A patient has massive proteinuria from diffuse podocyte injury but no prominent glomerular inflammation. Which syndrome is most expected?

A) Nephrotic syndrome

B) Nephritic syndrome

C) Obstructive uropathy

D) Acute pyelonephritis

A patient has glomerular inflammation that narrows capillary loops and reduces filtration. Which clinical pattern is most expected?

A) Hematuria and azotemia

B) Isolated glycosuria

C) Pure lipiduria only

D) Polyuria without proteinuria

Most glomerular injury involves 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) Basket-weave

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

A pathologist describes immune complexes as “lumpy-bumpy” along the glomerulus. Which immunofluorescence pattern is being described?

A) Granular

B) Linear

C) Pauci-immune

D) Basket-weave

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

A) Circulating immune complexes

B) Anti-GBM autoantibodies

C) Direct bacterial invasion

D) Tubular toxin injury

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

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) Albumin reabsorption

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

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 patient has nephritic syndrome one to two weeks after pharyngitis. Which organism most commonly causes this pattern?

A) Staphylococcus aureus

B) Streptococcus

C) Escherichia coli

D) Pseudomonas

A streptococcal infection triggers nephritic syndrome through a mechanism 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 two 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) Minimal change disease

C) Membranous nephropathy

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

A patient develops nephritic syndrome two weeks after streptococcal infection, and biopsy shows granular deposits with humps. Which diagnosis fits best?

A) Postinfectious glomerulonephritis

B) Primary membranous nephropathy

C) Anti-GBM disease

D) Diabetic nephropathy

A child with postinfectious GN has hematuria and edema after throat infection. What is the simplest pathophysiologic sequence?

A) Infection → immune complexes → inflammation

B) Infection → nephrin mutation → lipiduria

C) Infection → collagen defect → deafness

D) Infection → PLA2R antibody → sclerosis

Rapidly progressive glomerulonephritis is identified histologically by which hallmark lesion?

A) Fatty casts

B) Crescent shapes

C) Zebra bodies

D) Tram-track membranes

A renal biopsy in rapidly progressive GN shows crescent material in Bowman space. Which material commonly lines these crescents?

A) IgA

B) Amyloid

C) Hemosiderin

D) Fibrin

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

A severe nephritic syndrome progresses quickly to renal failure because the capillary wall ruptures and fibrin enters Bowman space. Which biopsy lesion should be expected?

A) Crescents

B) Humps

C) Tram-tracks

D) Fatty casts

Most patients with rapidly progressive crescentic glomerulonephritis have antibody type?

A) ANA

B) ANCA

C) Anti-dsDNA only

D) Anti-CCP

A patient has rapidly progressive GN but little immune deposition on immunofluorescence. Which mechanism is most likely?

A) ANCA-associated pauci-immune injury

B) Anti-PLA2R podocyte injury

C) IgA mesangial deposition

D) Type IV collagen mutation

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 pattern?

A) Linear anti-GBM staining

B) Granular IgA staining

C) Subepithelial humps

D) Mesangial C3 only

A patient has pulmonary hemorrhage, hematuria, and anti-GBM antibodies. Which tissue target explains both lung and kidney involvement?

A) Basement membrane

B) Distal tubule

C) Renal papilla

D) Collecting duct

A patient with severe Goodpasture syndrome has rapidly progressive kidney failure. Which histologic feature may be seen?

A) Crescent shapes

B) Myxomatous degeneration

C) Fatty casts

D) Humped subepithelial deposits

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) Minimal change disease

C) Goodpasture syndrome

D) Diabetic sclerosis

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

A patient has nephrotic syndrome from podocyte injury caused by anti-PLA2R antibodies. Which diagnosis is most likely?

A) Membranous nephropathy

B) Goodpasture syndrome

C) IgA nephropathy

D) Postinfectious GN

A patient has nephrotic syndrome with granular immunofluorescence from immune deposits near podocytes. Which diagnosis best fits?

A) Anti-GBM disease

B) Primary membranous nephropathy

C) Alport syndrome

D) Acute tubular necrosis

A patient has nephrotic syndrome due to membranous nephropathy. Which mechanism best explains the proteinuria?

A) Complement-mediated podocyte injury

B) Ureteral obstruction

C) Macula densa ischemia

D) RBC cast formation

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

Minimal change disease treatment?

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) Colon adenocarcinoma

B) Hodgkin lymphoma

C) Hepatocellular carcinoma

D) Pancreatic adenocarcinoma

Compared with children, minimal change disease in adults is less common and generally has which 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 child has nephrotic syndrome with normal light microscopy but diffuse podocyte effacement on EM. Why does light microscopy look normal?

A) Injury is ultrastructural

B) Injury affects ureters only

C) Deposits are always absent in blood

D) Collagen is never involved

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

A) Minimal change disease

B) Membranous nephropathy

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 glomerulosclerosis is 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, excellent response

B) No, poor response

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 pathophysiology?

A) Linear GBM staining, crescents

B) Focal podocyte lesions, mesangial sclerosis

C) IgA deposits, glycosylation defects

D) Humps, hypercellularity, strep infection

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

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 membranoproliferative glomerulonephritis with subendothelial deposits. Which MPGN subtype is most likely?

A) Type II MPGN

B) Type I MPGN

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

A patient has chronic hepatitis C and 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

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

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 patient has MPGN with thickened capillary walls that split around cellular interposition. Which light microscopy description is classic?

A) Tram-track membranes

B) Spike-and-dome deposits

C) Crescentic necrosis

D) Basket-weave collagen

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 patient develops recurrent hematuria soon after upper respiratory infections, and biopsy shows mesangial IgA deposition. Which diagnosis is most likely?

A) IgA nephropathy

B) Minimal change disease

C) Goodpasture syndrome

D) FSGS

In IgA nephropathy, where do the immune deposits primarily accumulate?

A) Subepithelial space

B) Mesangium

C) Linear GBM surface

D) Tubular lumen

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

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

A patient has hematuria, 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 patient has a type IV collagen defect causing abnormal GBM structure. Which biopsy description is most associated?

A) Basket-weave GBM

B) Subepithelial humps

C) Diffuse foot effacement

D) Linear IgG only

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-Schönlein purpura

D) Type II MPGN

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

A) IgG4 subepithelial deposits

B) IgA deposits

C) Anti-GBM antibodies

D) C3 dense deposits

A patient with SLE has rising creatinine, hypertension, and proteinuria. Which glomerulopathy pattern is most classically associated with nephrotic syndrome in SLE?

A) Membranous type

B) Minimal change type

C) Alport type

D) Berger type

A patient has immune complex disease. Which pattern should be expected on immunofluorescence?

A) Granular staining

B) Linear staining

C) Fatty cast pattern

D) Zebra body pattern

A child has postinfectious GN. Why does kidney disease appear after, not during, the initial infection?

A) Immune complexes form after infection

B) Nephrin mutates after fever

C) Collagen IV disappears immediately

D) Podocytes regenerate too quickly

A patient has postinfectious GN with low complement and granular deposits. Which biopsy finding best supports the diagnosis?

A) Subepithelial humps

B) Basket-weave GBM

C) Diffuse foot effacement

D) Collapsing sclerosis

A patient has nephrotic syndrome with immune deposits on the outer side of the GBM. Which disease is most likely?

A) Membranous nephropathy

B) Goodpasture syndrome

C) Alport syndrome

D) IgA nephropathy

A patient has mixed nephritic-nephrotic disease with tram-track membranes and hepatitis C. Which disease is most likely?

A) Type I MPGN

B) Minimal change disease

C) Goodpasture syndrome

D) FSGS

A patient has hereditary nephritis with GBM splitting and lamellation. Which electron microscopy phrase is most likely?

A) Basket-weave GBM

B) Foot process effacement

C) Humped deposits

D) Spike-and-dome deposits

A patient has postinfectious GN. Which electron microscopy phrase is most likely?

A) Humped subepithelial deposits

B) Basket-weave GBM

C) Diffuse podocyte effacement only

D) Dense intramembranous C3 bands

A patient has type II MPGN. Which electron microscopy phrase is most likely?

A) Dense deposits

B) Humped deposits

C) Linear antibodies

D) No ultrastructural change

A patient has membranous nephropathy. Which immune finding is most characteristic?

A) Granular IgG along GBM

B) Linear anti-GBM staining

C) Mesangial IgA only

D) No immune deposits

A patient has nephrotic syndrome with no hematuria and good steroid response. Which underlying glomerular target is most directly affected?

A) Podocyte foot processes

B) Type IV collagen genes

C) GBM anti-collagen antibodies

D) Mesangial IgA deposits

A student is trying to connect named findings to diseases. Which pairing is most accurate?

A) Humps-postinfectious; tram tracks-MPGN

B) Humps-Alport; tram tracks-minimal change

C) Humps-Goodpasture; tram tracks-FSGS

D) Humps-Berger; tram tracks-membranous

A student is trying to connect nephritic diseases. Which list contains mostly nephritic or nephritic-dominant diseases?

A) Postinfectious GN, Berger, Goodpasture, Alport

B) Minimal change, FSGS, membranous, amyloid

C) FSGS, minimal change, diabetes, membranous

D) Nephrosis, lipiduria, podocyte effacement, PLA2R

A student is trying to connect nephrotic diseases. Which list contains mostly nephrotic or nephrotic-dominant diseases?

A) Minimal change, FSGS, membranous

B) Goodpasture, Alport, Berger

C) Postinfectious GN, RPGN, HSP

D) ANCA, anti-GBM, crescents

A student is trying to understand crescents. Which statement best explains why crescents are dangerous?

A) They reflect severe GBM rupture

B) They indicate albumin leakage

C) They show normal podocyte repair

D) They prove isolated tubular infection

A patient has chronic viral hepatitis with immune complex-mediated glomerular disease and tram tracks. Which mechanism best captures the pathogenesis?

A) Chronic antigenemia drives MPGN

B) T-cell dysfunction causes MCD

C) Anti-GBM antibodies cause linear staining

D) Collagen IV mutation causes lamellation