《Slide 125.》Benign nephrosclerosis with malignant change, Kidney

A. Brief Descriptions：

1. Benign nephrosclerosis is the term used for the kidney associated with sclerosis of renal arterioles and small arterioles.

2. Pathogenesis: medial and intimal thickening, as a response to hemodynamic changes, genetic defects; hyaline deposition in arterioles.

3. Malignant nephrosclerosis is the form of renal disease associated with the malignant or accelerated phase of hypertension.

B. Gross Findings：

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C. Micro Findings：

1. Thickening of the vessel wall & narrowing of the lumen of afferent glomerular arterioles with obsolescence of glomeruli.

2. Glomeruli: ischemic wrinkling of the tuft & thickening of the Bowman's capsule,some glomeruli will be completely hyalinized, & fibrosis.

3. Tubule: atrophy with thickening basement membrane & containing hyaline casts.

4. Blood vessel: hyaline deposit in intima & media of arterioles; subendothelial fibrosis & lipid deposit in large vessels; thinned media & dilated lumen in sclerotic medium-sized arteries; lamellated interlobular vessels.

5. Interstitium: fibrosis & patchy chronic inflammation.

D. Others:

1. Hypertensive nephrosclerosis (arteriolar sclerosis).

2. Malignant phase (malignant hypertension):

   • Retinal change in the presence of diastolic pressure in excess of 125mmHg.

   • Fibrinoid necrosis of small arteries & arterioles especially at the branching point of an afferent arterioles & where it enters the glomerulus.

   • Wrinkling & duplication of base membrane as well as fibrinoid necrosis.

   • Mesengial cellular proliferation & crescent formation of glomeruli, inflammation usually scanty.

   •  Marked atrophy of tubules with hemorrhage (hematuria).

   • Proliferative (onion skin) endoarteritis & arteriolar necrosis.

E. Reference：

1. Robbins Pathologic Basis of Disease, 6^th ed.  p.981-984

　

 

 

【 Fig. 125-1 (20X)】Some glomerulus undergoes sclerosing change.

　

 

 

【 Fig. 125-2 (20X)】Some glomerulus reveals ischemic wrinkling of the tuft & thickening of the Bowman's capsule and  will be completely hyalinized, & fibrosis.

　

 

 

【 Fig. 125-3 (10X)】Thickened and sclerosing vessel.

　

 

 

【 Fig. 125-4 (40X)】Thickened and sclerosing vessel.

　

 

 

【 Fig. 125-5 (4X)】Marked atrophy of tubules with hemorrhage.

　

 

 

【 Fig. 125-6 (4X)】Arteriolosclerosis with narrowing lumen.

　

 

 

【 Fig. 125-7 (10X)】Atrophic tubules with thickening basement membrane & containing hyaline casts and chronic inflammatory infiltrate.

　

 

 

【 Fig. 125-8 (20X)】Some glomerulus undergoes sclerosing change.

　

 

 

【 Fig. 125-9 (20X)】Onion skin-like sclerosing vessels.

　

 

 

【 Fig. 125-10 (20X)】Sclerosing vessel.