Nephrosclerosis (NS) is an example of the visceral complications seen with the hypertensive patient. There are two types of NS - benign NS and malignant NS. These correspond strongly with the type of underlying hypertension that the patient manifests. In benign NS, the kidneys appear shrunken and granular on gross inspection as seen in this specimen. Histologically, there is intimal "onion-skinning" due to the proliferation of the endothelial cells and their associated basement membranes. There is also medial thickening caused by hyperplasia of the smooth muscle cells. In the arterioles, hyaline deposits are seen in the wall of the arteriole (arteriolosclerosis). This leads to a narrowing of the lumen with a resultant ischemia of the parenchyma. The resultant scarring gives the kidney its granular appearance.
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