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A 44-year-old woman dies as a consequence of a "stroke". At autopsy, she is found to have a large right basal ganglia hemorrhage. She has an enlarged 550 gm heart with predominantly left ventricular hypertrophy. Her kidneys are small, about 80 gm each, with cortical scarring, and microscopically they demonstrate small renal arterioles that have luminal narrowing from concentric intimal thickening. Which of the following is the most likely diagnosis?

A. Dominant polycystic kidney disease
B. Arterial changes with diabetes mellitus
C. Vascular disease with hyperlipidemia
D. Malignant hypertension
E. Monckeberg's sclerosis


i will go for D


(D) CORRECT. The small arteries of the kidney are affected by hyperplastic arteriolosclerosis. Malignant hypertension is often preceded by chronic hypertension that leads to left ventricular hypertrophy. Hypertension is a risk for CNS hemorrhage.

This was the given answer. But I always thought that in malignant HTN kidney's are "large, swollen" [BRS Pathology, 3rd edition, page 131] confused

I would choose C confused


i woulda thought B..
can u exlain more on hyperplastic and hyline arteriolosclerosis--microscopic findings wise?


hi arpita,

you can check out page nr 156 goljan rr

gud luck


heve the 500pages. will look it up tho.. grin


Hyaline arteriosclerosis occurs in DM & HTN. But the hyperplastic arteriosclerosis occurs in malignant HTN & splenic arteries.


hi confusion , its answer is malignant hypertension. question is giving us clue about hypertensive site of hemorrhage and in kidney cortical scarring with small kidney with intimal proliferation show hyaline arteriosclerosis...nephrosclerosis..v shaped scar....


ohh sorry..its hyperplastic arteiosclerosisgrin

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