A renal biopsy from a 46-year-old woman with accelerated phase hypertension shows arterioles with concentric laminated thickening of the wall producing an onion-skin appearance and markedly narrowed lumens. This lesion is:

• A Hyaline arteriolosclerosis
• B Fibrinoid necrosis
• C Hyperplastic arteriolosclerosis ✓
• D Monckeberg medial calcific sclerosis

Explanation

Hyperplastic arteriolosclerosis, with concentric onion-skin laminations from smooth muscle cell proliferation and basement membrane duplication, is the characteristic vascular lesion of severe or malignant hypertension. The most tempting distractor is fibrinoid necrosis, which also occurs in malignant hypertension but appears as smudgy eosinophilic necrosis of the vessel wall rather than laminated thickening. Hyaline arteriolosclerosis is seen in benign hypertension and diabetes.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.