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

Question 1 Explanation:

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

Question 2

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

Question 2 Explanation:

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

Question 3

What type of hypersensitivity is Goodpasture syndrome?

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

Question 3 Explanation:

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

Question 4

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

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

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

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

What nephrotic disease would you suspect?

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

Question 5 Explanation:

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

Question 6

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

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

Question 6 Explanation:

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

What is a defining feature of minimal change disease?

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

Question 8 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 9

Which nephrotic syndrome is associated with HIV?

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

Question 9 Explanation:

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

Question 10

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

A	Ears
B	Kidneys
C	Liver
D	Eyes

Question 10 Explanation:

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

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