A very common vascular histologic finding in patients with hypertensive nephrosclerosis is arteriosclerosis. In advanced lesions, such as this example, there is prominent intimal fibrosis with narrowing of the vessel lumen. The replacement of smooth muscle cells in the tunica media by fibrous tissue is thought to result from collagen and elastic tissue synthesis by myointimal cells. The degree of intimal fibrosis is thought to be more closely associated with elevated blood pressure than the degree of hyaline arteriolosclerosis.
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