Renal biopsy in a patient with accelerated phase hypertension shows arteriolar walls thickened by concentric laminations of smooth muscle cells and basement membrane material. What is this lesion called?

• A Hyaline arteriolosclerosis
• B Fibrinoid necrosis of the interlobular artery
• C Monckeberg medial calcific sclerosis
• D Hyperplastic arteriolosclerosis with onion skinning ✓

Explanation

Malignant hypertension produces hyperplastic arteriolosclerosis, in which concentric layers of smooth muscle and basement membrane give an onion skin appearance, often accompanied by fibrinoid necrosis and necrotizing arteriolitis. Hyaline arteriolosclerosis is the lesion of benign hypertension and diabetes, with homogeneous pink hyaline deposition. Monckeberg sclerosis affects muscular artery media and does not narrow the lumen, and it is unrelated to accelerated hypertension.

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

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