What is your diagnosis?
This image is of a silver stain showing an artery with a small arteriole budding off the right side. The artery shows mucoid intimal edema (the pale blue/purple) as well as near total lumen occlusion and focal fibrin deposition in the expanded intima. The arteriole shows lumen occlusion by intraluminal hyaline accumulation and focal fibrin deposition. These vascular findings are commonly seen in the setting of thrombotic microangiopathy, which is the diagnosis here. This patient presented with accelerated hypertension and subsequent renal failure. As the majority of the arteries show near total lumen occlusion, prognosis is guarded.
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