What histologic feature is typical of chronic hypertension-related nephrosclerosis?

• A. Fibrinoid necrosis of arterioles
• B. Hyaline arteriolosclerosis with thickened arteriolar walls and narrowed lumens
• C. Hyperplastic arteriolosclerosis
• D. Kimmelstiel-Wilson nodules

Answer: (B)

Chronic hypertension causes hyaline arteriolosclerosis of the small renal vessels. On histology, this looks like homogeneous pink (hyaline) thickening of the arteriolar walls with narrowing of the lumens. The wall thickening arises from leakage of plasma proteins into the vessel wall and increased production of extracellular matrix by smooth muscle cells, which together reduce blood flow to the kidney.

This reduced perfusion leads to ischemic injury of the glomeruli over time, contributing to nephrosclerosis, glomerulosclerosis, and chronic kidney disease.

For contrast, malignant hypertension shows hyperplastic arteriolosclerosis with onion-skinning and may include fibrinoid necrosis, while diabetic nephropathy produces nodular glomerulosclerosis (Kimmelstiel-Wilson nodules).