An 8-year-old boy from Palakkad is brought to the paediatric OPD with cola-coloured urine and puffy eyelids, two weeks after a sore throat. BP is 138/90 mmHg. Urine shows red cell casts and 1+ protein, ASO titre is raised and serum C3 is low. If a renal biopsy were done, what would electron microscopy most likely show?

Subepithelial electron-dense humps

Diffuse effacement of foot processes only

Splitting and lamination of the GBM

A 47-year-old woman's creatinine rises from 1.0 to 4.8 mg/dL over 3 weeks, with red cell casts in the urine. Her renal biopsy shows crescents in most glomeruli. Which cells mainly form these crescents?

Parietal epithelial cells with monocytes and macrophages

Podocytes with effaced foot processes

Endothelial cells with fibrin thrombi

Mesangial cells with deposited IgA

A 5-year-old boy with generalised oedema and 4+ proteinuria goes into complete remission after 3 weeks of oral prednisolone. If a renal biopsy had been done before treatment, which electron microscopy finding would have been the main abnormality?

Effacement of podocyte foot processes

Dense deposits within the mesangium

Subendothelial deposits with a split GBM

Subepithelial immune-complex humps

A 49-year-old man has a 5 cm renal mass found on an abdominal ultrasound done for dyspepsia. The nephrectomy specimen shows a well-circumscribed tan-brown tumour. Microscopy shows large pale cells with very prominent cell membranes, wrinkled nuclei and clear perinuclear halos. Cytogenetics shows loss of several whole chromosomes. What is the most likely diagnosis?

Chromophobe renal cell carcinoma

Clear cell renal cell carcinoma

Kidney and urinary tract pathology

26 NEET-PG practice questions on Kidney and urinary tract pathology, part of Pathology. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
An 8-year-old boy from Palakkad is brought to the paediatric OPD with cola-coloured urine and puffy eyelids, two weeks after a sore throat. BP is 138/90 mmHg. Urine shows red cell casts and 1+ protein, ASO titre is raised and serum C3 is low. If a renal biopsy were done, what would electron microscopy most likely show?
1. ADiffuse effacement of foot processes only
2. BSubepithelial electron-dense humps
3. CSplitting and lamination of the GBM
4. DLinear deposits along the GBM
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Answer: B · Subepithelial electron-dense humps
This is acute post-streptococcal glomerulonephritis, a nephritic syndrome after infection with a nephritogenic group A streptococcus. Immune complexes deposit on the outer (subepithelial) side of the GBM as discrete humps, and light microscopy shows enlarged, hypercellular glomeruli with neutrophils. Low C3 reflects activation of the alternative pathway and returns to normal within about 8 weeks. Biopsy is not needed in a typical child; most recover with fluid and salt restriction and treatment of hypertension.
- A: Isolated foot process effacement is minimal change disease, which causes nephrotic, not nephritic, syndrome.
- C: A split, laminated GBM is Alport syndrome, a hereditary nephritis with normal complement.
- D: Linear deposits are seen on immunofluorescence in anti-GBM disease, not as EM humps.
Question 2 · Easy
A 47-year-old woman's creatinine rises from 1.0 to 4.8 mg/dL over 3 weeks, with red cell casts in the urine. Her renal biopsy shows crescents in most glomeruli. Which cells mainly form these crescents?
1. APodocytes with effaced foot processes
2. BEndothelial cells with fibrin thrombi
3. CMesangial cells with deposited IgA
4. DParietal epithelial cells with monocytes and macrophages
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Answer: D · Parietal epithelial cells with monocytes and macrophages
Crescents are the hallmark of rapidly progressive glomerulonephritis. They form when severe injury ruptures the glomerular capillary wall, letting fibrin and inflammatory cells into Bowman space. Proliferating parietal epithelial cells and infiltrating monocytes and macrophages then fill the space, compressing the tuft. Immunofluorescence (linear, granular or pauci-immune) is then used to find the cause.
- A: Podocyte foot process effacement is the lesion of minimal change disease.
- B: Endothelial injury with thrombi is thrombotic microangiopathy, not crescent formation.
- C: Mesangial IgA deposits define IgA nephropathy; crescents are formed outside the tuft, not by mesangial cells.
Question 3 · Hard
A paediatric oncology registrar is teaching about Wilms tumour and writes: 1. Beckwith-Wiedemann syndrome with hemihypertrophy predisposes to it. 2. Diffuse anaplasia indicates unfavourable histology and is linked with TP53 mutation. 3. Bilateral tumours are the usual presentation. 4. Nephrogenic rests in the adjacent kidney are regarded as precursor lesions. Which statements are correct?
1. A1, 3 and 4 only
2. B2 and 3 only
3. C1 and 2 only
4. D1, 2 and 4 only
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Answer: D · 1, 2 and 4 only
Statements 1, 2 and 4 are correct. Beckwith-Wiedemann syndrome (an imprinting disorder at 11p15, the WT2 locus) with organomegaly, macroglossia and hemihypertrophy carries an increased risk of Wilms tumour. Diffuse anaplasia, with large hyperchromatic pleomorphic nuclei and abnormal mitoses, marks unfavourable histology and correlates with TP53 mutations and chemoresistance. Nephrogenic rests are persistent foci of embryonic renal tissue regarded as precursors, so their presence in the remaining kidney warns of a risk of a second tumour. Statement 3 is false: most Wilms tumours are unilateral, and bilateral disease is a minority.
- A: Includes statement 3 (most Wilms tumours are unilateral) and leaves out anaplasia.
- B: Includes bilateral tumours as usual, which is false, and leaves out statements 1 and 4.
- C: Leaves out nephrogenic rests, which are accepted precursor lesions.
Question 4 · Easy
A 5-year-old boy with generalised oedema and 4+ proteinuria goes into complete remission after 3 weeks of oral prednisolone. If a renal biopsy had been done before treatment, which electron microscopy finding would have been the main abnormality?
1. ADense deposits within the mesangium
2. BSubendothelial deposits with a split GBM
3. CSubepithelial immune-complex humps
4. DEffacement of podocyte foot processes
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Answer: D · Effacement of podocyte foot processes
Steroid-sensitive nephrotic syndrome in a young child is almost always minimal change disease. The glomeruli look normal on light microscopy and immunofluorescence is negative; the only consistent lesion is diffuse effacement of podocyte foot processes on electron microscopy. The resulting selective proteinuria is mostly albumin. Because the response to steroids is so reliable, children are treated without a biopsy unless they are steroid resistant or atypical.
- A: Mesangial deposits are typical of IgA nephropathy, which presents with haematuria.
- B: Subendothelial deposits with GBM duplication are membranoproliferative glomerulonephritis.
- C: Subepithelial humps are post-infectious glomerulonephritis, which is nephritic.
Question 5 · Hard
A 49-year-old man has a 5 cm renal mass found on an abdominal ultrasound done for dyspepsia. The nephrectomy specimen shows a well-circumscribed tan-brown tumour. Microscopy shows large pale cells with very prominent cell membranes, wrinkled nuclei and clear perinuclear halos. Cytogenetics shows loss of several whole chromosomes. What is the most likely diagnosis?
1. AClear cell renal cell carcinoma
2. BPapillary renal cell carcinoma
3. CChromophobe renal cell carcinoma
4. DRenal oncocytoma
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Answer: C · Chromophobe renal cell carcinoma
Pale cells with plant-like prominent cell membranes, raisin-like nuclei with perinuclear halos, and loss of multiple whole chromosomes (hypodiploidy) define chromophobe renal cell carcinoma. It arises from intercalated cells of the collecting duct and has a better prognosis than clear cell carcinoma. Oncocytoma, from the same cell line, is the main differential: it has granular eosinophilic oncocytes without halos and is benign. Clear cell carcinoma has 3p loss, and papillary carcinoma typically gains chromosomes 7 and 17.
- A: Clear cell RCC is golden-yellow with 3p (VHL) loss, not multiple whole-chromosome losses.
- B: Papillary RCC has papillae with foamy macrophages and gains of chromosomes 7 and 17.
- D: Oncocytoma has uniform granular eosinophilic cells without prominent membranes or halos.
Question 6 · Medium
A 59-year-old man has intermittent haematuria and a dull left flank ache. His haemoglobin is 19.2 g/dL with a normal white cell and platelet count and normal oxygen saturation. CT shows a 7 cm solid mass in the upper pole of the left kidney. What is the most likely mechanism of his raised haemoglobin?
1. AErythropoietin secreted by the tumour
2. BHypoxia from pulmonary metastases
3. CHaemoconcentration from tumour-induced diuresis
4. DA JAK2 mutation in marrow stem cells
Answer and explanation in LearnFree account
Question 7 · Hard
A urology resident preparing for a seminar on clear cell renal cell carcinoma writes: 1. It arises from the epithelium of the proximal tubule. 2. Loss of VHL lets HIF accumulate and drive VEGF expression. 3. It has a tendency to grow into the renal vein. 4. It arises from the intercalated cells of the collecting duct. Which statements are correct?
1. A2 and 4 only
2. B2, 3 and 4 only
3. C1 and 3 only
4. D1, 2 and 3 only
Answer and explanation in LearnFree account
Question 8 · Medium
A 52-year-old man has had blood-stained nasal crusting and sinusitis for 3 months, now with haemoptysis. Chest X-ray shows cavitating nodules, urine has red cell casts and creatinine has risen to 3.9 mg/dL. Renal biopsy shows segmental necrosis with crescents and scanty immune deposits on immunofluorescence. Which serological test is most likely to be positive?
1. AAnti-proteinase 3 ANCA
2. BAnti-myeloperoxidase ANCA
3. CAnti-double-stranded DNA
4. DAnti-GBM antibody
Answer and explanation in LearnFree account
Question 9 · Medium
A 57-year-old woman has had poorly controlled rheumatoid arthritis for 20 years. She now has oedema and proteinuria of 6 g/day, with a normal-sized kidney on ultrasound. Renal biopsy shows amorphous eosinophilic material in the glomeruli and vessel walls, which shows apple-green birefringence after Congo red staining. What is this material most likely derived from?
1. ATransthyretin
2. BBeta-2 microglobulin
3. CSerum amyloid A protein
4. DImmunoglobulin light chains
Answer and explanation in LearnFree account
Question 10 · Hard
A 44-year-old woman received many months of oral cyclophosphamide for lupus nephritis 8 years ago. She now has painless gross haematuria, and cystoscopic biopsy shows a high-grade urothelial carcinoma. Which drug metabolite is chiefly blamed for injuring her bladder urothelium?
1. AChloroacetaldehyde
2. BAcrolein
3. CPhosphoramide mustard
4. DCarboxyphosphamide
Answer and explanation in LearnFree account
Question 11 · Easy
A 56-year-old smoker in Lucknow has painless haematuria and a right flank mass. Nephrectomy shows a golden-yellow tumour with haemorrhage, made of cells with clear cytoplasm in a delicate vascular network. Loss of which gene is most typical of this tumour?
1. AWT1
2. BTSC2
3. CVHL
4. DMET
Answer and explanation in LearnFree account
Question 12 · Medium
A 6-year-old boy is brought to a paediatric OPD with a raised purpuric rash over his buttocks and legs, painful knees and colicky abdominal pain for a week. Urine shows microscopic haematuria with red cell casts. Platelet count and coagulation tests are normal. If a renal biopsy is done, what will immunofluorescence most likely show?
1. AGranular IgG and C3 along capillary walls
2. BMesangial IgA deposits
3. CLittle or no immunoglobulin
4. DLinear IgG along the GBM
Answer and explanation in LearnFree account
Question 13 · Medium
A 61-year-old woman who has spent decades painting in a closed workshop has had falling urine output for 2 weeks. She has no cough, haemoptysis, rash or sinus symptoms. Creatinine is 6.1 mg/dL with red cell casts. Renal biopsy shows crescents in 85% of glomeruli and linear IgG along the glomerular basement membrane. Which antigen is the target of her antibodies?
1. AAlpha-3 chain of type IV collagen
2. BPhospholipase A2 receptor on podocytes
3. CProteinase 3 in neutrophil granules
4. DNephrin in the slit diaphragm
Answer and explanation in LearnFree account
Question 14 · Medium
A 46-year-old man with untreated chronic hepatitis C has palpable purpura on his legs, joint pains, haematuria and proteinuria of 2.5 g/day. Serum C4 is very low and rheumatoid factor is positive. Renal biopsy shows lobulated, hypercellular glomeruli with double-contoured capillary walls and intraluminal hyaline thrombi. What is the most likely diagnosis?
1. ACryoglobulinaemic membranoproliferative glomerulonephritis
2. BIgA vasculitis with nephritis
3. CPauci-immune crescentic glomerulonephritis
4. DPrimary membranous nephropathy
Answer and explanation in LearnFree account
Question 15 · Medium
A 22-year-old woman with seizures since childhood and red papules over her nose and cheeks has bilateral renal masses on CT. The masses contain areas of fat density. Biopsy shows thick-walled blood vessels, smooth muscle and mature fat. What is the diagnosis?
1. ARenal medullary fibroma
2. BRenal oncocytoma
3. CPapillary renal cell carcinoma
4. DAngiomyolipoma
Answer and explanation in LearnFree account
Question 16 · Easy
A 54-year-old man worked for 20 years in a textile dye factory in Surat and has smoked bidis since his teens. He now has painless gross haematuria. Cystoscopy shows a papillary tumour on the bladder wall. What is the most likely histological type?
1. ASmall cell carcinoma
2. BUrothelial carcinoma
3. CAdenocarcinoma
4. DSquamous cell carcinoma
Answer and explanation in LearnFree account
Question 17 · Easy
A mother in a Kozhikode village notices a firm swelling in the left flank of her 3-year-old daughter while bathing her. The child is otherwise well. A resected renal tumour shows small round blue blastemal cells, primitive tubules and spindle-cell stroma. What is the diagnosis?
1. ANeuroblastoma
2. BClear cell sarcoma of the kidney
3. CWilms tumour
4. DCongenital mesoblastic nephroma
Answer and explanation in LearnFree account
Question 18 · Medium
A baby born at 37 weeks with a placenta weighing nearly half the birth weight develops massive proteinuria and generalised oedema in the second week of life. The parents are first cousins. Genetic testing shows biallelic mutations in NPHS1. Which protein is defective?
1. AType IV collagen alpha-5 chain
2. BAlpha-actinin 4
3. CPodocin
4. DNephrin
Answer and explanation in LearnFree account
Question 19 · Medium
A 2-year-old boy with absent irises in both eyes since birth and hypospadias with undescended testes is referred for genetic counselling. Karyotype shows a small deletion on the short arm of chromosome 11. Which gene loss puts him at high risk of a childhood renal tumour?
1. AWT1
2. BWT2
3. CNPHS1
4. DVHL
Answer and explanation in LearnFree account
Question 20 · Medium
A 5-year-old boy with relapsing steroid-sensitive nephrotic syndrome is in relapse with gross ascites. He develops fever of 39.4°C, diffuse abdominal tenderness and vomiting. Ascitic fluid shows 1,200 neutrophils/µL. Which organism is most likely responsible?
1. ABacteroides fragilis
2. BStaphylococcus aureus
3. CStreptococcus pneumoniae
4. DCandida albicans
Answer and explanation in LearnFree account
Question 21 · Medium
A 28-year-old man is being treated for nodular sclerosis Hodgkin lymphoma. During his second cycle of chemotherapy he develops sudden oedema, with proteinuria of 7 g/day, normal BP and a bland urine sediment. Which glomerular lesion is most likely?
1. ADiabetic glomerulosclerosis
2. BAmyloidosis of AL type
3. CMembranous nephropathy
4. DMinimal change disease
Answer and explanation in LearnFree account
Question 22 · Medium
During a ward round in a paediatric nephrology unit, a resident lists urine and clinical findings and asks which favour a nephritic rather than a nephrotic picture: 1. Red cell casts. 2. Oval fat bodies with Maltese crosses under polarised light. 3. Hypertension with reduced urine output. 4. Proteinuria above 3.5 g/day. Which findings favour nephritic syndrome?
1. A3 and 4 only
2. B1 and 3 only
3. C1 and 4 only
4. D1, 2 and 3 only
Answer and explanation in LearnFree account
Question 23 · Hard
A 66-year-old man who has smoked for 45 years has lost 8 kg in 4 months and now has oedema. Urine protein is 6.8 g/day with a bland sediment. Renal biopsy shows thickened capillary walls with subepithelial deposits, and serum anti-PLA2R antibody is negative; tissue PLA2R staining is also negative. What is the most appropriate next step?
1. AScreen for an occult solid cancer
2. BStart rituximab for primary disease
3. CRepeat the biopsy for electron microscopy
4. DStart high-dose oral prednisolone alone
Answer and explanation in LearnFree account
Question 24 · Medium
A 34-year-old man on no treatment for HIV has swelling of both legs. Urine protein is 8 g/day, creatinine 2.6 mg/dL, and ultrasound shows large echogenic kidneys. Renal biopsy shows collapse of the glomerular tufts, hypertrophied podocytes and dilated tubules containing proteinaceous casts. What is the diagnosis?
1. ACollapsing focal segmental glomerulosclerosis
2. BMinimal change disease
3. CPost-infectious glomerulonephritis
4. DMembranous nephropathy
Answer and explanation in LearnFree account
Question 25 · Medium
A 9-year-old girl from Assam who is a known HBsAg carrier is admitted with generalised oedema. Urine protein is 4.2 g/day, serum albumin 2.0 g/dL and urine sediment is bland. Renal biopsy shows diffusely thickened capillary walls with normal cellularity. What would electron microscopy most likely show?
1. AFoot process effacement without any deposits
2. BSubepithelial deposits with intervening GBM spikes
3. CSubendothelial deposits with a double-contoured GBM
4. DMesangial deposits with mesangial proliferation
Answer and explanation in LearnFree account

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Kidney and urinary tract pathology

A 47-year-old woman's creatinine rises from 1.0 to 4.8 mg/dL over 3 weeks, with red cell casts in the urine. Her renal biopsy shows crescents in most glomeruli. Which cells mainly form these crescents?

A 5-year-old boy with generalised oedema and 4+ proteinuria goes into complete remission after 3 weeks of oral prednisolone. If a renal biopsy had been done before treatment, which electron microscopy finding would have been the main abnormality?

A 44-year-old woman received many months of oral cyclophosphamide for lupus nephritis 8 years ago. She now has painless gross haematuria, and cystoscopic biopsy shows a high-grade urothelial carcinoma. Which drug metabolite is chiefly blamed for injuring her bladder urothelium?

A 56-year-old smoker in Lucknow has painless haematuria and a right flank mass. Nephrectomy shows a golden-yellow tumour with haemorrhage, made of cells with clear cytoplasm in a delicate vascular network. Loss of which gene is most typical of this tumour?

A 22-year-old woman with seizures since childhood and red papules over her nose and cheeks has bilateral renal masses on CT. The masses contain areas of fat density. Biopsy shows thick-walled blood vessels, smooth muscle and mature fat. What is the diagnosis?

A 54-year-old man worked for 20 years in a textile dye factory in Surat and has smoked bidis since his teens. He now has painless gross haematuria. Cystoscopy shows a papillary tumour on the bladder wall. What is the most likely histological type?

A mother in a Kozhikode village notices a firm swelling in the left flank of her 3-year-old daughter while bathing her. The child is otherwise well. A resected renal tumour shows small round blue blastemal cells, primitive tubules and spindle-cell stroma. What is the diagnosis?

A baby born at 37 weeks with a placenta weighing nearly half the birth weight develops massive proteinuria and generalised oedema in the second week of life. The parents are first cousins. Genetic testing shows biallelic mutations in NPHS1. Which protein is defective?

A 2-year-old boy with absent irises in both eyes since birth and hypospadias with undescended testes is referred for genetic counselling. Karyotype shows a small deletion on the short arm of chromosome 11. Which gene loss puts him at high risk of a childhood renal tumour?

A 5-year-old boy with relapsing steroid-sensitive nephrotic syndrome is in relapse with gross ascites. He develops fever of 39.4°C, diffuse abdominal tenderness and vomiting. Ascitic fluid shows 1,200 neutrophils/µL. Which organism is most likely responsible?

A 28-year-old man is being treated for nodular sclerosis Hodgkin lymphoma. During his second cycle of chemotherapy he develops sudden oedema, with proteinuria of 7 g/day, normal BP and a bland urine sediment. Which glomerular lesion is most likely?