Figure 623

Chronic TIN associated with hypertension. The arrows indicate arterioles and small arteries with thickened walls. Tubular degeneration, interstitial fibrosis, and mononuclear inflammatory cell infiltration are part of the degenerative process that affects the kidneys in all vascular diseases involving the intrarenal vasculature with any degree of severity as to cause ischemic injury. Rarely, if the insult is sudden and massive (such as in fulminant vasculitis), the lesions are those of infarction and acute deterioration of renal function. More commonly, the vascular lesions develop gradually and go undetected until renal insufficiency supervenes. This chronic form of TIN accounts for the tubulointerstitial lesions of arteriolar nephrosclerosis in persons with hypertension. Ischemic vascular changes also contribute to the lesions of TIN in patients with diabetes, sickle cell hemoglobinopathy, cyclosporine nephrotoxicity, and radiation nephritis.

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