Kumar: Robbins Basic Pathology, 9th Edition

Chapter 13: Kidney and Its Collecting System

Test Bank
MULTIPLE CHOICE
1. This nephrectomy specimen shows a lesion in the kidney of a 63-year-old man. The lesion is
most likely related to

a.
b.
c.
d.
e.

a deletion of von Hippel-Lindau (VHL) tumor suppressor gene

a mutation of myc oncogene
an amplification of ras oncogene
a loss of bcl-2 proapoptotic gene
an aflatoxin related carcinogen

ANS: A
The kidney contains a large renal cell carcinoma. These tumors contain large amounts of lipids,
which accounts for their yellow color on gross examination and the clear appearance of cells in
routine microscopic slides. Deletions of the von HippelLindau mutations are found in most
clear renal cell carcinomas.
PTS:

2. The normal glomerular basement membrane is composed of which type of collagen?

a. Type I
b. Type II
c. Type III
d. Type IV
e. Type V
ANS: D
Copyright 2013, 2007, 2003, 1997, 1992, 1987, 1981, 1976, 1971 by Saunders, an imprint of Elsevier Inc.

Test Bank

13-2

Similar to other basement membranes, the glomerular basement membrane is composed of

collagen type IV. It is a helical molecule composed of six genetically distinct chains (1 to 6).
Mutation of the gene for the 5 chain of collagen type IV causes hereditary glomerulopathy of
Alport syndrome.
PTS:

3. A 5-year-old boy is taken to the pediatrician because of generalized facial edema and
somnolence. He has been passing dark brown urine. Physical examination reveals hypertension.
Urinalysis shows oliguria, hematuria, proteinuria, and red blood cell casts. Which of the
following is the most likely diagnosis?
a. Nephritic syndrome
b. Nephrotic syndrome
c. Rapidly progressive acute renal failure
d. Chronic uremia
e. Nephrolithiasis
ANS: A
These clinical findings are typical signs and symptoms associated with nephritic syndrome,
which is most likely caused by acute glomerulonephritis.
PTS:

4. The PKD1 gene encoding polycystin-1 is a large integral membrane protein. It is typically found
in persons who have which of the following diseases?
a. Childhood polycystic kidney disease
b. Adult polycystic disease
c. Adult onset renal medullary cystic disease
d. Glomerulocystic disease
e. Acquired renal cystic disease
ANS: B
The PKD1 gene encoding polycystin-1 is mutated in most persons who have autosomal
dominant polycystic kidney disease (PKD), which is also known as adult PKD. This disease is
frequently associated with polycystic liver disease and berry aneurysms of the circle of Willis.
PTS:

5. A 30-year-old heroin addict who is positive for the human immunodeficiency virus (HIV) is
hospitalized because of generalized edema. Laboratory studies show proteinuria,
hypoalbuminemia, hyperlipidemia, and lipiduria. Which of the following diseases is most likely
to be diagnosed by a biopsy of the kidney?
a. Lipoid nephrosis
b. Focal segmental glomerulosclerosis
c. Membranous nephropathy
d. IgA nephropathy
e. Amyloidosis

Copyright 2013, 2007, 2003, 1997, 1992, 1987, 1981, 1976, 1971 by Saunders, an imprint of Elsevier Inc.

Test Bank

13-3

ANS: B
Clinical findings indicate that this patient has nephrotic syndrome. The most likely cause of
nephrotic syndrome in a patient who is HIV-positive is focal segmental glomerulosclerosis.
PTS:

6. Which kidney disease characterized by nephrotic syndrome, microscopic hematuria, and

glomerular deposits of C3 complement and properdin is caused by an autoantibody called C3
nephritic factor?
a. Membranoproliferative glomerulonephritis type II
b. Focal segmental glomerulosclerosis
c. Membranous nephropathy
d. IgA nephropathy
e. Acute postinfectious glomerulonephritis
ANS: A
Deposits of C3 complement and properdin in the glomerular basement membranes, visible by
electron microscopy in the form of ribbon-like densities and associated with low serum
complement, are typical of membranoproliferative glomerulonephritis type II. This kidney
disease is caused by C3 nephritic factor, an autoantibody binding to the alternative complement
pathway regulating enzyme C3 convertase.
PTS:

7. Membranoproliferative glomerulonephritis caused by mixed cryoglobulinemia is most often

secondary to which of the following diseases?
a. Diabetes mellitus
b. Multiple myeloma
c. Membranous nephropathy
d. Amyloidosis
e. Human immunodeficiency virus infection
ANS: C
Membranoproliferative glomerulonephritis caused by mixed cryoglobulinemia is most often a
complication of viral hepatitis C. The glomeruli contain deposits of IgG-IgM cryoglobulins,
which are also found in the small blood vessels of the skin and joints, resulting in cutaneous
vasculitis with petechial hemorrhages and synovitis.
PTS:

Copyright 2013, 2007, 2003, 1997, 1992, 1987, 1981, 1976, 1971 by Saunders, an imprint of Elsevier Inc.