How does malignant hypertension appear histologically in small arteries?

How does malignant hypertension appear histologically in small arteries?

• A. Fibrinoid necrosis of arterioles and hyperplastic onion-skin arteriolosclerosis
• B. Hyaline arteriulosclerosis with hyaline deposition
• C. Atherosclerotic plaque formation in renal arteries
• D. Transmural inflammation with granulomas

Answer: (A)

In malignant hypertension, the vessels endure such severe pressure that the endothelial lining is damaged and plasma proteins leak into the wall, producing fibrinoid necrosis in the walls of small arteries and arterioles. At the same time, smooth muscle cells proliferate and the basement membrane thickens in a concentric, laminated fashion, giving the characteristic onion-skin appearance—hyperplastic arteriolosclerosis. This combination—fibrinoid necrosis plus hyperplastic arteriolosclerosis—is what distinguishes malignant hypertension histologically from other vascular changes. By contrast, hyaline arteriolosclerosis with homogeneous hyaline deposits is more typical of benign hypertension or diabetes and lacks the fibrinoid necrosis and onion-skinning seen here. Other choices describe processes not typical for malignant hypertension: atherosclerotic plaques involve larger arteries, and transmural inflammation with granulomas points to vasculitides like polyarteritis nodosa.

In malignant hypertension, the vessels endure such severe pressure that the endothelial lining is damaged and plasma proteins leak into the wall, producing fibrinoid necrosis in the walls of small arteries and arterioles. At the same time, smooth muscle cells proliferate and the basement membrane thickens in a concentric, laminated fashion, giving the characteristic onion-skin appearance—hyperplastic arteriolosclerosis. This combination—fibrinoid necrosis plus hyperplastic arteriolosclerosis—is what distinguishes malignant hypertension histologically from other vascular changes. By contrast, hyaline arteriolosclerosis with homogeneous hyaline deposits is more typical of benign hypertension or diabetes and lacks the fibrinoid necrosis and onion-skinning seen here. Other choices describe processes not typical for malignant hypertension: atherosclerotic plaques involve larger arteries, and transmural inflammation with granulomas points to vasculitides like polyarteritis nodosa.