Which one of the following gross appearances of a kidney is most characteristic of malignant nephrosclerosis?
Renal aeriolar changes in malignant nephrosclerosis (malignant hypeension) include fibrinoid necrosis of aerioles (necrotizing aeriolitis), hyperplastic aeriolosclerosis (onion-skinning), necrotizing glomerulitis, and often a thrombotic microangiopathy. Grossly, multiple small petechial hemorrhages are found on the surface of the kidneys. The clinical course is often downhill, with only 50% of patients surviving 5 years; marked proteinuria, hematuria, cardiovascular problems, and finally renal failure contribute to death. The disease is often associated with accelerated preexisting benign essential hypeension, chronic renal disease (glomerulonephritis), or scleroderma In contrast, benign nephrosclerosis (renal disease occurring in benign hypeension) is characterized by hyaline aeriolosclerosis with thickened, hyalinized aeriolar walls and narrowed lumina. Fibroelastic hyperplasia occurs in the larger muscular aeries. Small kidneys with a finely granular surface often result because of ischemic atrophy of nephrons. Broad Ushaped coical scars overlying dilated calyces in the renal poles are seen with chronic pyelonephritis (reflux causes scars involving poles only, while obstruction produces scars all over the kidney), depressed coical areas overlying necrotic papillae of varying stages are seen with analgesic nephropathy and diabetes mellitus, multiple small white areas on the surface are seen with acute pyelonephritis, and wedge-shaped (i.e., V-shaped) pale coical scars are seen with renal infarcts. Reference: Robbins & Cotran Pathologic Basis of Disease, 9edition
Broad U-shaped coical scars overlying dilated calyces in renal poles
Depressed coical areas overlying necrotic papillae of varying stages
Multiple small petechial hemorrhages on the surface
Multiple small white areas on the surface
miscellaneous