Figure 1151

Scleroderma. In the acute phase, small- and medium-sized renal arteries show mucoid thickening of the intima with severe narrowing of the lumen. Sometimes these lesions are accompanied by thrombosis and fibrinoid necrosis of the arterioles and glomeruli. Morphologically, the vascular alterations resemble malignant nephrosclerosis (malignant hypertension) or hemolytic-uremic syndrome. In the chronic phase, the mucoid intimal material is replaced by fibrous tissue.

A, Severe narrowing of a small-sized renal artery owing to extensive endothelial widening with ischemia of glomeruli. B, Accumulation of mucopolysaccharide material in the widened endothelial layer.

(Continued on next page)

FIGURE 11-51 (Continued)

C, Severe intimal fibrosis of a medium-sized artery of a more chronic phase of scleroderma. (Panel A, methenamine silver, original magnification X 100. Panel B, alcian blue stain, original magnification X100. Panel C, cellulose acetate butyrate stain, original magnification X150.)

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