Renal biopsy from a 35-year-old woman with severe hypertension (blood pressure 220/140 mm Hg) shows arterioles with smudgy, homogeneous, intensely eosinophilic material in their walls, accompanied by luminal narrowing and focal fibrin thrombi. This vascular change represents:

• A Amyloid deposition
• B Hyaline arteriolosclerosis
• C Medial calcific sclerosis
• D Fibrinoid necrosis of vessel walls ✓

Explanation

Malignant hypertension causes fibrinoid necrosis of arteriolar walls: severe pressure injury damages endothelium, allowing plasma proteins including fibrin to insudate into the wall, which appears smudgy and intensely eosinophilic on H&E. Hyaline arteriolosclerosis is seen in benign hypertension and diabetes as bland, glassy pink thickening without necrosis or thrombosis. Amyloid is Congo red positive with apple-green birefringence, and Monckeberg sclerosis is a medial calcification of muscular arteries unrelated to hypertension.

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.