A 45-year-old man with accelerated hypertension has fundoscopy showing flame hemorrhages and papilledema. Renal biopsy shows concentric laminated thickening of arteriolar walls with narrowed lumens. This vascular change is termed:

• A Hyperplastic arteriolosclerosis with onion-skin layering ✓
• B Hyaline arteriolosclerosis
• C Monckeberg medial calcific sclerosis
• D Fibrinoid necrosis of the glomerular tuft

Explanation

Hyperplastic arteriolosclerosis is the hallmark of malignant or accelerated hypertension. Repeated cycles of plasma protein leakage and smooth muscle proliferation produce concentric laminations of the arteriolar wall, the onion-skin lesion, with severe luminal narrowing. In severe cases there may be superimposed fibrinoid necrosis of the vessel wall. Hyaline arteriolosclerosis is the homogeneous pink thickening seen in benign hypertension and diabetes mellitus, and Monckeberg sclerosis is medial calcification of muscular arteries that does not narrow the lumen.

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.