Page 264 - Concise Pathology for Exam Preparation ( PDFDrive )

10 Blood Vessels 249

Onion skin
appearance

Lumen

Hyperplastic
intimal smooth
muscle cells

FIGURE 10.5. Hyperplastic arteriolosclerosis showing onion skinning (H&E; 1003).

Effects on Kidneys (Hypertensive Renal Disease)
Hypertensive renal disease may present as any of the following morphological patterns:
1. Benign nephrosclerosis: It is the spectrum of renal changes associated with the benign
phase of hypertension. Benign nephrosclerosis is the most common form of renal dis-
ease in persons over 60 years of age (common autopsy finding), and its severity in-
creases in the presence of diabetes mellitus.
Clinical features:
• Variable elevation of blood pressure
• Headache and dizziness
• Palpitations and nervousness
• Renal function tests and urine examination may be normal in early stage; however,
the patient may manifest with mild proteinuria and presence of hyaline and granular
casts in the late stage.
Gross pathology:
• Both kidneys are reduced in size and weight due to cortical scarring (small con-
tracted kidneys).
• The capsule is adherent to cortical surface, which appears finely granular and re-
sembles leather grain.
Microscopic findings:
• Vascular changes
• Hyaline arteriolosclerosis: Homogeneous eosinophilic thickening (hyalinization) of
the walls of small arteries and arterioles
• Intimal thickening: Proliferation of smooth muscle cells in the intima of the arcuate
and interlobular arteries along with medial hypertrophy and reduplication of in-
ternal elastic lamina
• Parenchymal changes
• Glomerular shrinkage
• Deposition of collagen in Bowman’s space
• Periglomerular fibrosis and complete sclerosis of the glomerulus
• Tubular atrophy and fine interstitial fibrosis
2. Malignant nephrosclerosis: A manifestation of malignant or accelerated hypertension,
this pattern is uncommon and usually occurs as a superimposed complication in 5%
cases of pre-existing benign hypertension; can occur in pure form also.

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