A renal biopsy from a 34-year-old woman with BP 230/140 mmHg shows thickening of the wall of small arteries and arterioles by concentric laminations of proliferating smooth muscle cells and duplicated basement membrane, giving an onion-skin appearance. Which vascular lesion is this?

• A Hyaline arteriolosclerosis
• B Hyperplastic arteriolosclerosis ✓
• C Monckeberg medial calcific sclerosis
• D Fibrinoid necrosis limited to the afferent arteriole

Explanation

Hyperplastic arteriolosclerosis, the onion-skin lesion, is characteristic of severe or malignant hypertension. Hyaline arteriolosclerosis instead shows homogeneous pink glassy thickening and is seen in benign nephrosclerosis and diabetes mellitus, making it the key distractor. Monckeberg sclerosis is medial calcific stiffening of muscular arteries in older adults and does not narrow the lumen. Fibrinoid necrosis accompanies the necrotizing arteriolitis of malignant hypertension but describes smudgy eosinophilic vessel wall necrosis, not lamination.

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.