Nephritic and Nephrotic Syndromes Quiz

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Question 1

A woman with a history significant for lupus is found to have 2.3 grams of protein in her urine each day. In the investigation you find wire looping of the capillaries on light microscopy. Which of the following tops your differential?

A	IgA nephropathy
B	Diffuse proliferative glomerulonephritis
C	Focal segmental glomerulosclerosis
D	Rapidly progressive Glomerulonephritis

Question 1 Explanation:

Wire looping should be a term that you associate with Diffuse Proliferative Glomerulonephitis.

Question 2

Which nephrotic syndrome has a "tram-track" appearance on light microscopy?

A	Diabetic glomerulonephritis
B	Diffuse proliferative glomerulonephritis
C	Berger's disease
D	Membranoproliferative glomerulonephritis
E	RGPN

Question 2 Explanation:

Membranoproliferative glomerulonephritis has a "tram-track" appearance on LM. Diabetic glomerulonephritis is the only other answer that is a nephrotic syndrome, the rest are nephritic syndromes.

Question 3

Which syndrome shoes a spike and dome appearance on electron microscopy?

A	Goodpasture syndrome
B	Berger's disease (IgA nephropathy)
C	Membranous glomerulonephritis
D	Accute post streptococcal GN
E	Alport syndrome

Question 3 Explanation:

Membranous glomerulonephritis has a spike and dome appearance on EM. It is also the most common cause of adult nephrotic syndrome.

Question 4

What type of hypersensitivity is Goodpasture syndrome?

A	Type II
B	Type I
C	Type III
D	Type IV

Question 4 Explanation:

Goodpasture syndrome is a type II hypersensitivity with antibodies against the glomerular basement membrane.

Question 5

What is a defining feature of minimal change disease?

A	Slight visible changes of the glomeruli on light microscoty
B	Effacement of the foot processes on electron mycroscopy
C	Blunting of the villi on light microscopy
D	Segmental sclerosis on light microscopy

Question 5 Explanation:

Minimal change disease shows normal glomeruli on LM and effacement of the foot processes on EM. Minimal change is most often seen in children.

Question 6

Which nephrotic syndrome is associated with HIV?

A	Focal Segmental Glomerulosclerosis
B	IgA Nephropathy
C	Minimal Change Disease
D	Amyloidosis

Question 6 Explanation:

Focal Segmental Glomerulosclerosis is the most common glomerular disease in patients with HIV.

Question 7

A patient complains of excessively frothy urine when he uses the toilet in the morning. Thickening of the glomerular basement membrane and Kimmelstiel-Wilson lesions are seen on light microscopy.

What has been the major cause of this patients current condition?

A	Antibodies to the glomerular and alveolar basement membranes
B	Poor control of glucose levels
C	Recent streptococcal infection
D	SLE

Question 7 Explanation:

Kimmelstiel-Wilson lesions are a defining feature of diabetic glomerulonephropathy.

Question 8

Which of the following is NOT a part of the body affected in Alport syndrome?

A	Kidneys
B	Eyes
C	Liver
D	Ears

Question 8 Explanation:

Alport syndrome is a type IV collagen defect that leads to eyesight changes, deafness, and nephrotic syndrome.

Question 9

Which of the following characteristics is used to define a nephritic syndrome?

A	Fatty casts in urine
B	Polyuria and hypotension
C	Protein in the urine (under 3.5 grams per day)
D	Red Blood Cell casts in urine with a decreased BUN and creatinine

Question 9 Explanation:

One of the defining features used to determine the difference between nephritic and nephrotic syndromes is the amount of protein in the urine. Nephritic syndromes have under 3.5 g/day. Nephrotic syndromes have over 3.5 g/day. Fatty casts are a feature of nephrotic syndromes.

Question 10

This image shows apple-green birefringence with Congo-red stain on light microscopy.

What nephrotic disease would you suspect?

A	Minimal change disease
B	Amyloidosis
C	Wegener's granulomatosis
D	Diabetic glomerulonephropathy

Question 10 Explanation:

Amyloidosis is associated with many chronic conditions, and is often described as "apple-green birefringence" on a Congo-red stain on LM.

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