A 70-year-old man is brought to the hospital by his son for evaluation of worsening fatigue. The patient has not seen a physician in the past 15 years. He takes naproxen occasionally for knee arthritis. Physical examination of the prostate shows no abnormalities. Laboratory results are as follows: Urine sediment is unremarkable. Ultrasound examination shows bilateral small kidneys and no hydronephrosis. Kidney biopsy shows intimal thickening and luminal narrowing of the renal arterioles with evidence of glomerular sclerosis. Which of the following is most likely responsible for this patient's kidney disease?

Question

A 70-year-old man is brought to the hospital by his son for evaluation of worsening fatigue.  The patient has not seen a physician in the past 15 years.  He takes naproxen occasionally for knee arthritis.  Physical examination of the prostate shows no abnormalities.  Laboratory results are as follows:  Urine sediment is unremarkable.  Ultrasound examination shows bilateral small kidneys and no hydronephrosis.  Kidney biopsy shows intimal thickening and luminal narrowing of the renal arterioles with evidence of glomerular sclerosis.  Which of the following is most likely responsible for this patient's kidney disease?

Quizplus · Accepted Answer

Eductional Objective: Chronic hypertension can result in hypertensive nephrosclerosis, which is characterized by compensatory medial hypertrophy and fibrointimal proliferation; endothelial damage from elevated systemic pressure also leads to hyaline arteriolosclerosis.  The narrowed arteriolar lumens cause a progressive decrease in renal blood flow, resulting in glomerular ischemia and fibrosis (glomerulosclerosis).

A 70-Year-Old Man Is Brought to the Hospital by His