MEDizzy - A 53-year-old man presents with severe headaches, nausea,

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Urinary System

A 53-year-old man presents with severe headaches, nausea, and vomiting. He also relates seeing spots before his eyes and is found to have a diastolic blood pressure of 160 mm Hg. Microscopic examination of a renal biopsy demonstrates hyperplastic arteriolitis. Gross examination of his kidneys is most likely to reveal which one of the following changes?

ExplanationMalignant hypertension is characterized clinically by finding a diastolic blood pressure greater than 130 mm Hg. Additional clinical signs and symptoms of malignant hypertension include severe headache, ear noises, flame-shaped retinal hemorrhages with AV-nicking, and papilledema. The renal changes associated with malignant hypertension are called malignant nephrosclerosis. These characteristic changes include fibrinoid necrosis of arterioles (necrotizing arteriolitis), hyperplastic arteriolosclerosis (onion skinning), necrotizing glomerulitis, and often a thrombotic microangiopathy. Grossly the kidney has a “flea-bitten” appearance with multiple red petechiae. 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 hypertension, chronic renal disease (glomerulonephritis), or scleroderma.