A 34-year-old man presents with headache, blurring of vision, and blood pressure of 230/140 mm Hg. Funduscopy shows grade IV retinopathy with papilledema. Renal biopsy of an arteriole shows concentric laminated thickening of the wall with narrowed lumen, resembling an onion cut in cross section, with fibrinoid necrosis in some vessels. This arteriolar change results from:
- A Amyloid light chain deposition within the vessel wall
- B Deposition of amorphous basement membrane material from chronic benign hypertension
- C Repeated cycles of endothelial injury, plasma protein leakage, and smooth muscle proliferation ✓
- D Granulomatous inflammation of the arteriolar wall
Correct answer: C. Repeated cycles of endothelial injury, plasma protein leakage, and smooth muscle proliferation
Explanation
Malignant hypertension produces hyperplastic arteriolosclerosis, the onion-skin lesion, formed by repeated cycles of severe pressure-induced endothelial injury, plasma leakage into the wall, smooth muscle cell hyperplasia and basement membrane reduplication. Fibrinoid necrosis signals necrotizing arteriolitis. Amorphous subendothelial hyaline thickening describes hyaline arteriolosclerosis of benign hypertension and diabetes, a different entity affecting different severity of disease.
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.