A 50-year-old man presents with blood pressure 220/140 mmHg and fundoscopy showing bilateral papilloedema. Renal biopsy is performed. Which pathological finding is most characteristic of this condition?
- A Onion-skin lesion of hyperplastic arteriolosclerosis
- B Thrombotic microangiopathy with fibrin thrombi
- C Fibrinoid necrosis of arterioles ✓
- D Nodular glomerulosclerosis
Correct answer: C. Fibrinoid necrosis of arterioles
Explanation
Malignant hypertension is defined pathologically by fibrinoid necrosis of arterioles and small arteries, reflecting acute severe vascular injury from markedly elevated blood pressure. Hyperplastic arteriolosclerosis with the onion-skin or concentric laminated lesion is the chronic adaptive change and is also present, but fibrinoid necrosis is the hallmark of the acute malignant phase. Thrombotic microangiopathy shows fibrin thrombi but is characteristic of HUS/TTP, not hypertension. Nodular glomerulosclerosis is diabetic nephropathy.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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