Arteriolosclerosis
Right breast mammograms showing several calcified arterioles. Patient 94 years old.
Specialty	Cardiology

Arteriolosclerosis is a form ofcardiovascular disease involving hardening and loss of elasticity ofarterioles orsmallarteries and is most often associated withhypertension anddiabetes mellitus.^[1]Types includehyaline arteriolosclerosis andhyperplastic arteriolosclerosis,^[2] both involved withvessel wall thickening andluminal narrowing that may cause downstreamischemic injury.The following two terms whilst similar, are distinct in both spelling and meaning and may easily be confused with arteriolosclerosis.

• Arteriosclerosis is any hardening (and loss of elasticity) of medium or large arteries (from the Greekarteria, meaningartery, andsclerosis, meaninghardening)
• Atherosclerosis is a hardening of an artery specifically due to anatheromatous plaque. The termatherogenic is used for substances or processes that cause atherosclerosis.

Alsoarterial hyalinosis andarteriolar hyalinosis refers to thickening of the walls of arterioles by the deposits that appear as homogeneous pinkhyaline material in routine staining.^[3] It is a type of arteriolosclerosis, which refers to thickening of thearteriolar wall and is part of the aging process.^[4]

Associations

It is associated withaging,hypertension,diabetes mellitus,^[5]dementia,^[6] and may be seen in response to certain drugs (calcineurin inhibitors).^[7]

It is often seen in the context of kidney pathology.^[4][8][9] In hypertension only the afferent arteriole is affected, while in diabetes mellitus, both theafferent andefferent arteriole are affected.^[8][9] It is also seen in retina and brain,^[10] whereretinal infarcts andsmall brain infarcts, or lacunes can occur.

Cause

Lesions reflect leakage ofplasma components acrossvascularendothelium and excessiveextracellular matrix production bysmooth muscle cells, usually secondary to hypertension.^[11]

Hyaline arteriolosclerosis is a major morphologic characteristic ofbenign nephrosclerosis, in which the arteriolar narrowing causes diffuse impairment ofrenalblood supply, with loss ofnephrons.^[5] The narrowing of the lumen can decrease renal blood flow and henceglomerular filtration rate leading to increasedrenin secretion and a perpetuating cycle with increasing blood pressure and decreasing kidney function.^[12]

The brain is another organ where hyaline arteriolosclerosis occurs prematurely in patients with high blood pressure. This can cause either kind ofstroke: anischemic infarct or abrain hemorrhage, as the vessels can be blocked or broken.^[13]

This is a type of arteriolosclerosis involving a narrowedlumen.^[4]The term "onion-skin" is sometimes used to describe this form of blood vessel^[14] with thickened concentric smooth muscle cell layer and thickened, duplicated basement membrane. Inmalignant hypertension these hyperplastic changes are often accompanied by fibrinoid necrosis of the arterial intima and media. These changes are most prominent in thekidney and can lead to ischemia and acutekidney failure. In the brain, a small cavity called a lacune is an ischemic cavity that can arise due to brain necrosis, due to arteriolosclerosis.^[15][16]

Cause

It can be caused by malignant hypertension.^[4][17]

• Vascular diseases

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