Kidney nontumor / medical renal

• Sclerosis of renal arterioles and small arteries, strongly associated with nonmalignant hypertension
• Hypertension can be both a cause and consequence of nephrosclerosis
• Hypertension associated nephrosclerosis is an important cause of chronic kidney disease (CKD) that affects African Americans disproportionately (Kidney Int Rep 2016;1:10)

• Arterionephrosclerosis is a diagnosis of exclusion as it can be the cause and consequence of hypertension
• Arterionephrosclerosis is often misdiagnosed and likely includes cases of both focal segmental glomerulosclerosis (FSGS) and non-FSGS glomerular diseases (J Am Soc Nephrol 2008;19:2047)
• Hyperechogenic kidneys on ultrasound

Contributed by Husam Jum’ah, M.D.


Images hosted on other servers:

Contributed by Santhi Ganesan, M.D.

Which of the following vasculature is affected by hyalinosis in arterionephrosclerosis?

1. Afferent arteriole
2. Both afferent and efferent arterioles
3. Efferent arteriole
4. Interlobar artery

A. Afferent arteriole. Arterionephrosclerosis (hypertension associated kidney disease) affects terminal branches of interlobular arteries, especially afferent arterioles as a response to hemodynamic changes and insudation of plasma proteins and subsequent afferent arteriolar hyalinosis. Answers B and C are incorrect because efferent arterioles are not affected. Diabetic nephropathy involves afferent and efferent arteriolar hyalinosis. Answer D is incorrect because interlobar artery shows medial thickening and subintimal fibrosis but no hyalinosis.

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Reference: Arterionephrosclerosis

Hypertension associated chronic kidney disease (CKD) can be associated with

1. Apolipoprotein E (APOE) genotype
2. COL4A5 mutations
3. G1 and G2 risk allele variants of apolipoprotein L1 (APOL1)
4. Phospholipase A2 receptor (PLA2R) antibodies

C. G1 and G2 risk allele variants of apolipoprotein L1 (APOL1). The presence of 2 APOL1 risk alleles (G1 and G2) can be associated with more proteinuria, more severe kidney disease and progression to end stage renal disease (ESRD) on follow up. Answer D is incorrect because PLA2R antibodies are associated with membranous glomerulopathy. Answer B is incorrect because COL4A5 mutations can be seen in association with focal segmental glomerulosclerosis. Answer A is incorrect because apolipoprotein E (APOE) genotype is implicated in Alzheimer disease.

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Reference: Arterionephrosclerosis

The vascular changes depicted in the image above represent which of the following processes or outcomes?

1. Atherosclerosis
2. Extravasation of plasma proteins through injured endothelium and increased deposition of basement membrane matrix in hypertension associated kidney disease
3. Fibrinoid necrosis of small vessel vasculitis
4. Misfolded proteinaceous material with a characteristic beta pleated sheet on electron microscopic examination

B. Extravasation of plasma proteins through injured endothelium and increased deposition of basement membrane matrix in hypertension associated kidney disease. Hypertension can be associated with vasoregulatory dysfunction at the level of the glomerular microcirculation. This image represents afferent arteriolar hyalinosis due to extravasation of plasma proteins through injured endothelium and increased deposition of basement membrane matrix in arterionephrosclerosis (hypertension associated kidney disease). This results in accumulation of homogeneous material that stains pink on H&E stained slides. Answer C is incorrect because fibrinoid necrosis of vasculitis is amorphous and stains bright pink in H&E stained slides. Answer D is incorrect because misfolded protein with beta pleated sheet of amyloid appears glassy and homogeneous and stains lighter pink in H&E stained slides. Answer A is incorrect because atherosclerosis is associated with atheromatous plaque and involves arterial walls characterized by accumulation of lipid, matrix material and calcium.

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Reference: Arterionephrosclerosis