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Pathology for Urologists

Benign Hypertension


Image A
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Image B
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  • Term "benign hypertension" is usually slight to moderate severity and of long duration; it does not imply etiology, although most often it is considered "essential" hypertension.
  • Benign nephrosclerosis is the term applied to the renal changes seen with long-standing benign hypertension.
  • Usually asymptomatic.
  • Two process induces:
    • Medial and intimal thickening as response to hemodynamic changes, aging, genetic defects combination.
    • Hyaline deposition in arterioles from plasma protein extravasation thru injured endothelium and deposition of basement membrane matrix.
  • Gross:
    • Kidneys are normal size or slightly shrunken (110-130 gm).
    • External surface is granular (image A) & (image B).
    • Sectioning reveals thinning of the renal cortex without evidence of medullary or calyceal scarring (as might be seen with pyelonephritis).

Image C
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Image D
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  • Histology:
    • Hyalinization and thickening of vessel walls results in narrowing of arteriolar lumina (image C).
    • Patchy ischemia can lead to scarring of glomeruli and atrophy/ hypertrophy of tubules (alternating areas of very small and very large tubules) (image D).
    • Subcapsular granularity due to scars.
  • Benign hypertension by itself rarely causes renal insufficiency or uremia, although there may occasionally be mild proteinuria.

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