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

Question 1 Explanation:

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

Question 2

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

What nephrotic disease would you suspect?

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

Question 2 Explanation:

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

Question 3

Which nephrotic syndrome is associated with HIV?

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

Question 3 Explanation:

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

Question 4

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

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

Question 4 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 5

What is a defining feature of minimal change disease?

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

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

A	Kidneys
B	Eyes
C	Liver
D	Ears

Question 6 Explanation:

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

Question 7

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

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

Question 7 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 8

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

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

Question 8 Explanation:

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

Question 9

What type of hypersensitivity is Goodpasture syndrome?

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

Question 9 Explanation:

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

Question 10

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

Question 10 Explanation:

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

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