Systemic pathology: renal papillary necrosis: 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 · Systemic pathology: renal papillary necrosis

Sample item

A 55-year-old man with diabetes and obstructive uropathy has flank colic, haematuria and passes sloughed tissue fragments in his urine. CT urography shows a ring-shaped filling defect in a calyx. What is the lesion?

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

The answer and the reasoning

A. Renal papillary necrosis

Renal papillary necrosis is ischaemic coagulative necrosis of the renal papillae, which sloughs and may obstruct the ureter. Causes include diabetes, analgesic nephropathy, sickle cell disease and obstruction with infection. The mnemonic is POSTCARD.

Option by option

  • A. Renal papillary necrosis (correct)

    Correct. Sloughed papillary tissue and a ring sign are characteristic.

  • B. Acute tubular necrosis

    Acute tubular necrosis is a tubular injury with muddy brown casts and no tissue passage.

  • C. Xanthogranulomatous pyelonephritis

    Xanthogranulomatous pyelonephritis is a chronic suppurative process with foamy macrophages and staghorn stones.

  • D. Acute cortical necrosis

    Acute cortical necrosis follows obstetric catastrophes or shock with anuria and does not slough papillae.

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, Renal papillary necrosis. Renal papillary necrosis is ischaemic coagulative necrosis of the renal papillae, which sloughs and may obstruct the ureter.

Why is "Acute tubular necrosis" not the answer?

Acute tubular necrosis is a tubular injury with muddy brown casts and no tissue passage.

Why is "Xanthogranulomatous pyelonephritis" not the answer?

Xanthogranulomatous pyelonephritis is a chronic suppurative process with foamy macrophages and staghorn stones.

Why is "Acute cortical necrosis" not the answer?

Acute cortical necrosis follows obstetric catastrophes or shock with anuria and does not slough papillae.

What concept does this question test?

It tests Systemic pathology: renal papillary necrosis in Pathology. Causes include diabetes, analgesic nephropathy, sickle cell disease and obstruction with infection. The mnemonic is POSTCARD.

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 Systemic pathology: renal papillary necrosis?

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.