Hyperplastic arteriolosclerosis with onion-skin lesions is most closely associated with which condition?

Hyperplastic arteriolosclerosis with onion-skin lesions is most closely associated with which condition?

• A. Hypertensive Crisis
• B. Atherosclerosis
• C. Diabetes Mellitus
• D. Malignant Hypertension

Answer: (D)

Hyperplastic arteriolosclerosis with onion-skin appearances arise when vessels in the kidney and other organs are subjected to very high pressures, triggering concentric proliferation of smooth muscle and duplication of the basement membrane in small arteries and arterioles. This dramatic vascular remodeling is the hallmark of malignant hypertension, the rapidly progressive form of hypertensive emergency that causes target-organ damage. In this setting you often also see fibrinoid necrosis of arterioles, underscoring the acute, severe vascular injury. Other conditions don’t show this onion-skin pattern. Hyaline arteriolosclerosis, seen with long-standing or milder hypertension and with diabetes, produces thickened, eosinophilic walls rather than concentric cellular layering. Atherosclerosis affects larger arteries with lipid-rich plaques, not the small arterioles. Therefore, the onion-skin hyperplastic arteriolosclerosis most closely aligns with malignant hypertension.

Hyperplastic arteriolosclerosis with onion-skin appearances arise when vessels in the kidney and other organs are subjected to very high pressures, triggering concentric proliferation of smooth muscle and duplication of the basement membrane in small arteries and arterioles. This dramatic vascular remodeling is the hallmark of malignant hypertension, the rapidly progressive form of hypertensive emergency that causes target-organ damage. In this setting you often also see fibrinoid necrosis of arterioles, underscoring the acute, severe vascular injury.

Other conditions don’t show this onion-skin pattern. Hyaline arteriolosclerosis, seen with long-standing or milder hypertension and with diabetes, produces thickened, eosinophilic walls rather than concentric cellular layering. Atherosclerosis affects larger arteries with lipid-rich plaques, not the small arterioles. Therefore, the onion-skin hyperplastic arteriolosclerosis most closely aligns with malignant hypertension.