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Malignant Hypertension

Pathology Editor: Agnes Fogo, MD
Medical Photographer: Brent Weedman
With Assistance From: Kim Solez, MD, of the National Kidney Foundation's cyberNephrologyTM Team

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Fig 1. In malignant hypertension, also called accelerated hypertension, there are often underlying changes as seen in hypertensive nephrosclerosis, with superimposed fibrinoid necrosis of the vessel wall. In this vessel, there is also fibrin within the vessel wall, as a consequence of the necrosis. Glomeruli show only ischemic changes. (Jones' silver stain, original magnification X100).
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Fig 2. Fibrinoid necrosis of the vessel wall with pink, amorphous fibrinoid material is present, with activated endothelial cells and inflammatory cells in this artery in a patient with malignant hypertension. There is also underlying medial thickening of the vessel wall, indicative of preexisting hypertensive injury. (Jones' silver stain, original magnification X200).
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Fig 3. The glomeruli in malignant or accelerated hypertension show only ischemic change, seen here as extensive corrugation of the glomerular basement membrane with expanded lamina rara interna. (Transmission electron microscopy, original magnification X8,000).

From the Department of Pathology, Vanderbilt University Medical Center, Nashville, TN.
Address author queries to Agnes Fogo, MD, Department of Pathology, Vanderbilt University Medical Center, MCN C-3310, Nashville, TN 37232.
Am J Kidney Dis 34(1):E1, 1999 (available
 Copyright 1999 by the National Kidney Foundation, Inc.

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