3.  A renal biopsy from a patient with a severe infection reveals a diffuse intracapillary proliferation with leukocytic infiltration and obliteration of capillary lumina. Subepithelial electron-dense “humps” are found on EM. Which of the following IF findings would be consistent with an infection caused by Staphylococcus aureus?

  4.  Which of the following morphologic or IF features favors a diagnosis of C3 glomerulopathy over that of classic membranoproliferative glomerulonephritis (MPGN)?

  5.  A 12-year-old boy has nephrotic syndrome and low complement levels. The most significant findings on renal biopsy are demonstrated in these PAS (A) and methenamine silver–stained sections (B). Mesangial and glomerular capillary deposition of C3 and IgG was detected by IF. EM showed large subendothelial electron-dense deposits with mesangial interposition. Which of the following is the most likely diagnosis?

  6.  The ultrastructural changes seen in this EM picture are pathognomonic of:

  7.  Which of the following is true about crescentic glomerulonephritis?

  8.  Which of the following glomerular lesions is shown in this picture of a PAS-stained section?

  9.  A 4-year-old child presents with nephrotic syndrome, and a renal biopsy shows no light microscopic changes. Ultrastructural changes are shown in this picture. Which of the following immunofluorescence findings would be most likely present?

10.  A clinical evaluation of a young adult with generalized edema shows heavy proteinuria (4.5 g/day). The past medical history is unremarkable. In the United States, which of the following is the most common glomerular disease accounting for this presentation?

11.  An adult patient presents with nephrotic syndrome, and a renal biopsy reveals the glomerular changes depicted in this photomicrograph. Which of the following ultrastructural alterations is most likely found in the glomeruli that appear normal on light microscopy?

12.  Focal segmental glomerulosclerosis (FSGS) is the usual morphologic pattern of HIV-associated nephropathy (HIVAN). Which of the following light microscopic changes is most characteristic of HIVAN?

13.  A renal biopsy is performed on a 34-year-old man for the evaluation of proteinuria in the nephrotic range. A representative silver-stained section is shown in the photomicrograph. IF demonstrates finely granular deposits of IgG and C3 along the capillary wall. EM shows effacement of foot processes, associated with numerous subepithelial electron-dense deposits, which are separated from each other by extensions of the basement membrane. Which of the following is the most likely diagnosis?

14.  A previously healthy 35-year-old woman presents with nephrotic syndrome. She has no other known significant condition. Laboratory tests reveal circulating IgG4 directed against the phospholipase A2 receptor (PLA2R). Which of the following is the most likely glomerular disease?

15.  A 55-year-old woman with a 15-year history of type 2 diabetes mellitus is found to have microalbuminuria. All other renal function tests are normal. At this early stage, the most likely glomerular change of diabetic nephropathy is:

16.  The glomerular lesion seen in this photomicrograph was found in a renal biopsy from a patient with long-standing diabetes mellitus. How is this glomerular change called?

17.  Which of the following is the most common form of glomerulonephritis worldwide and manifests with recurrent gross or microhematuria?

18.  Microscopic hematuria is discovered in an otherwise healthy 20-year-old man. There is a family history of similar abnormality. A renal biopsy appears normal on light microscopy, but the glomerular basement membrane is less than 200 nm thick on EM. Which of the following extrarenal abnormalities is most likely associated with this condition?

19.  A hereditary form of glomerulopathy caused by defective collagen synthesis and associated with sensorineural deafness and ocular abnormalities is:

20.  Which of the following conditions is most likely to be associated with the type of “bloodless” glomerulus, as depicted in this photomicrograph?

21.  A 35-year-old man presents with nephritic syndrome. Several years prior to this, he suffered from an episode of generalized purpura due to cryoglobulinemia. Which of the following ultrastructural changes is most characteristic of glomerular disease secondary to cryoglobulinemia?

22.  A 60-year-old woman with a long history of rheumatoid arthritis comes to medical attention because of heavy proteinuria. Which of the following alterations is most likely to be identified on a renal biopsy?

23.  A 40-year-old man presents with proteinuria in the nephrotic range, microhematuria, and hypertension. The patient does not have monoclonal gammopathy, lymphoproliferative disorders, or cryoglobulinemia. A renal biopsy reveals expansion of the mesangium and thickening of the glomerular capillary wall. IF staining with antibodies to IgG is shown in this picture. A Congo red stain is negative. Which of the following type of glomerular deposits would be most likely found by EM?

24.  A 30-year-old woman with systemic lupus erythematosus (SLE) undergoes a renal biopsy because of proteinuria and microhematuria. The biopsy shows glomerular changes consistent with class IV lupus nephritis according to the new classification by the International Society of Nephrology and the Renal Pathology Society (ISN/RPS). Which of the following glomerular changes is present in this renal biopsy?

25.  Which of the following morphologic parameters is used in the evaluation of the activity of lupus nephritis?

26.  A 65-year-old man with heavy proteinuria and hypertension undergoes a renal biopsy. The main biopsy finding consists of diffuse and nodular mesangial accumulation of PAS-positive material. IF reveals deposition of kappa light chain throughout the mesangium and along the GBM, as shown in this picture. On light microscopy, the glomerular changes of this condition may be very similar to