Onion-skin arteriolosclerosis, characterized by concentric laminated thickening of arteriolar walls, is most classically associated with which condition?

Onion-skin arteriolosclerosis, characterized by concentric laminated thickening of arteriolar walls, is most classically associated with which condition?

• A. Diabetes mellitus
• B. Atherosclerosis
• C. Malignant hypertension
• D. Systemic sclerosis

Answer: (C)

Onion-skin arteriolosclerosis is a sign of hyperplastic arteriolosclerosis due to severe, malignant hypertension. The extreme pressure injures small vessels and drives concentric proliferation of smooth muscle cells with reduplication of the basement membrane, producing the characteristic laminated, onion-like narrowing of arteriolar walls. This pattern is a classic vascular response to the abrupt, high blood pressures seen in malignant hypertension and is often most evident in the kidneys, where it can contribute to ischemic injury and fibrinoid necrosis of arterioles. This pattern isn’t typical of diabetes, which more commonly causes hyaline arteriolosclerosis with a uniform, eosinophilic thickening of arteriolar walls. Atherosclerosis targets large and medium arteries with lipid-rich plaques rather than small arterioles. Systemic sclerosis can affect small vessels, but the hallmark onion-skin laminated thickening is most classically linked to malignant hypertension.

Onion-skin arteriolosclerosis is a sign of hyperplastic arteriolosclerosis due to severe, malignant hypertension. The extreme pressure injures small vessels and drives concentric proliferation of smooth muscle cells with reduplication of the basement membrane, producing the characteristic laminated, onion-like narrowing of arteriolar walls. This pattern is a classic vascular response to the abrupt, high blood pressures seen in malignant hypertension and is often most evident in the kidneys, where it can contribute to ischemic injury and fibrinoid necrosis of arterioles.

This pattern isn’t typical of diabetes, which more commonly causes hyaline arteriolosclerosis with a uniform, eosinophilic thickening of arteriolar walls. Atherosclerosis targets large and medium arteries with lipid-rich plaques rather than small arterioles. Systemic sclerosis can affect small vessels, but the hallmark onion-skin laminated thickening is most classically linked to malignant hypertension.