PA27.8-17 | Renal Pathology II: Tubulointerstitial, Vascular & Neoplastic — Practice Quiz

Which of the following best classifies the cause of acute tubular necrosis (ATN) in a patient who develops oliguria 48 hours after an emergency laparotomy for ruptured aortic aneurysm with prolonged intraoperative hypotension?

A urine microscopy from a patient with oliguric ATN shows coarsely granular 'muddy-brown' casts. These casts form primarily from:

A 35-year-old woman presents with high fever, rigors, right loin pain, and dysuria for 3 days. Urine culture grows Escherichia coli >10⁵ CFU/mL. Urine microscopy is most likely to show:

A 58-year-old diabetic man with recurrent urinary tract infections develops sudden severe right flank pain and haematuria. CT shows a wedge-shaped, hypo-enhancing area at the right renal papilla. The most likely complication is:

Chronic pyelonephritis (reflux nephropathy) produces a characteristic gross appearance of the kidney. Which feature best distinguishes it from hypertensive nephrosclerosis?

A 68-year-old man with a 30-year history of poorly controlled hypertension has progressive CKD. Renal biopsy shows concentric lamination of the arteriolar wall producing an 'onion-skin' appearance with luminal obliteration. This lesion is characteristic of:

A 7-year-old girl develops bloody diarrhoea after eating undercooked beef. Five days later she develops oliguria, haematuria, and thrombocytopenia. Her blood film shows fragmented red cells (schistocytes). ADAMTS13 levels are normal. The pathogenesis of her renal injury is best explained by:

A 45-year-old man is found to have bilateral flank masses on routine examination. Imaging reveals bilaterally enlarged kidneys with multiple cysts replacing the parenchyma. His father died of a subarachnoid haemorrhage at age 50. The gene most likely mutated in this patient encodes:

A 55-year-old obese man presents with left flank pain. Plain X-ray of the abdomen shows a radiolucent filling defect in the left renal pelvis. Urinalysis reveals a pH of 5.0. Stone composition is most likely:

A 70-year-old man with benign prostatic hyperplasia presents with bilateral hydronephrosis and rising creatinine. The primary mechanism of progressive renal damage in chronic hydronephrosis is:

A 60-year-old smoker presents with painless gross haematuria. Cystoscopy reveals a papillary lesion in the bladder trigone. Urinary cytology shows atypical cells. The most important occupational carcinogen associated with this malignancy is:

CLINICAL VIGNETTE: A 62-year-old man presents with a 2-month history of left flank pain, visible haematuria, and a palpable left abdominal mass. CT scan shows a 9 cm heterogeneous left renal mass with involvement of the left renal vein and a pulmonary nodule ('cannonball metastasis'). Serum calcium is 12.5 mg/dL. The tumour most likely arises from and is driven by:

CLINICAL VIGNETTE: A 3-year-old girl presents with a large abdominal mass discovered incidentally by her mother during bathing. Ultrasound shows a well-encapsulated right renal mass. Histology reveals blastemal cells, stromal spindle cells, and poorly formed glomeruloid tubular structures. This triphasic pattern is diagnostic of:

CLINICAL VIGNETTE: A 50-year-old woman with uncontrolled hypertension and microangiopathic haemolytic anaemia undergoes renal biopsy. Pathology shows fibrinoid necrosis of afferent arterioles with intraluminal fibrin-platelet thrombi in glomerular capillaries, alongside the onion-skin lesion in interlobular arteries. These findings together are most consistent with: