Which of the following is a characteristic feature of malignant hypertension?
Ans: A (Fibrinoid necrosis) Ref: Robbins Pathologic Basis of Disease, 8th edition, Pg:495Explanation:Fibrinoid necrosis is a characteristic feature of Malignant hypertensionIt is also seen in immune vasculitis conditions (HSP), Preeclampsia, Acute Rheumatic fever and Hyperacute graft rejection.Accelerated or Malignant hypertensionA small percentage, perhaps 5%, of hypertensive persons show a rapidly rising blood pressure that, if untreated, leads to death within a year or two, called accelerated or malignant hypertension.This clinical syndrome is characterized by severe hypertension (i.e., systolic pressure over 200 mm Hg. diastolic pressure over 120 mm Hg), renal failure, and retinal hemorrhages and exudates, with or without papilledema.It may develop in previously normotensive persons but more often is superimposed on preexisting benign hypertension, either essential or secondaryThe characteristic morphological changes in vessels is termed as Hyperplastic Arteriolosclerosis Hyperplastic A rteriolosclerosisThis lesion occurs in severe (malignant) hypertension:Vessels exhibit "onion-skin lesions.'" characterized by concentric, laminated thickening of the walls and luminal narrowing.The laminations consist of smooth muscle cells with thickened, reduplicated basement membranes;In malignant hypertension they are accompanied by fibrinoid deposits and vessel wall necrosis (necrotizing arteriolitis). particularly in the kidney.Benign hypertensionMorphologyThe characteristic morphological changes in vessels is termed as hyaline arteriolosclerosis Hyaline ,4 rteriolosclerosis.Arterioles show homogeneous, pink hyaline thickening with associated luminal narrowing.These changes stem from plasma protein leakage across injured endothelial cells, and increased smooth muscle cell matrix synthesis in response to chronic hemodynamic stress.Although the vessels of elderly persons also frequently show hyaline arteriosclerosis, it is more generalized and severe in individuals with hypertension.The same lesions are also a common feature of diabetic microangiography (due to hyper- glycembia-induced endothelial cell dysfunction)In nephrosclerosis due to chronic hypertension, the arteriolar narrowing of hyaline arteriosclerosis causes diffuse impairment of renal blood supply and causes glomerular scarring.
Fibrinoid necrosis
Hyalinising and medial hyperplasia
Intimal hyperplasia
Nephrosclerosis
Atherosclerosis and Arteriosclerosis