Which histologic lesion is most characteristic of hypertensive nephrosclerosis?

• A. Glomerular immune complex deposition
• B. Hyaline arteriolosclerosis of afferent arterioles
• C. Podocyte effacement
• D. Subepithelial immune deposits

Answer: (B)

Chronic hypertension in the kidney mainly affects small vessels, so the characteristic histologic change is hyaline arteriolosclerosis of the afferent arterioles. The arteriolar walls become thickened and pink (hyaline) from plasma protein leakage into the wall and increased smooth muscle matrix, which narrows the vessel lumen. This reduced blood flow to the glomeruli causes ischemic injury, leading to glomerulosclerosis and progressive kidney dysfunction seen in hypertensive nephrosclerosis.

Other options describe processes you’d expect in different kidney diseases: immune complex deposition in the glomeruli signals immune glomerulonephritis rather than hypertensive vascular changes; podocyte effacement is typical of diseases like minimal change disease or focal segmental glomerulosclerosis; subepithelial immune deposits occur in membranous nephropathy.