Renal pathology: acute pyelonephritis: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Renal pathology: acute pyelonephritis

Sample item

A 28-year-old woman has fever, flank pain and dysuria. Which urinary finding most specifically localises the infection to the kidney rather than the bladder?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. White cell casts

Casts are moulded in the renal tubules, so leucocyte casts indicate that inflammatory cells have come from the tubulointerstitium. In acute pyelonephritis neutrophils infiltrate the interstitium and tubules, which fits with the presence of these casts. Pyuria alone cannot distinguish cystitis from pyelonephritis.

Option by option

  • A. White cell casts (correct)

    Correct. Casts form in tubules, so white cell casts show renal involvement.

  • B. Hyaline casts

    Hyaline casts of Tamm-Horsfall protein occur in normal concentrated urine.

  • C. Pyuria with positive leukocyte esterase

    Pyuria and leukocyte esterase occur equally in cystitis.

  • D. Red cell casts

    Red cell casts indicate glomerular bleeding as in glomerulonephritis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is A, White cell casts. Casts are moulded in the renal tubules, so leucocyte casts indicate that inflammatory cells have come from the tubulointerstitium.

Why is "Hyaline casts" not the answer?

Hyaline casts of Tamm-Horsfall protein occur in normal concentrated urine.

Why is "Pyuria with positive leukocyte esterase" not the answer?

Pyuria and leukocyte esterase occur equally in cystitis.

Why is "Red cell casts" not the answer?

Red cell casts indicate glomerular bleeding as in glomerulonephritis.

What concept does this question test?

It tests Renal pathology: acute pyelonephritis in Pathology. In acute pyelonephritis neutrophils infiltrate the interstitium and tubules, which fits with the presence of these casts. Pyuria alone cannot distinguish cystitis from pyelonephritis.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Renal pathology: acute pyelonephritis?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.