arteriolosclerosis

Arteriolosclerosis is the medical term for thickening and hardening of the walls of small arteries and arterioles, leading to luminal narrowing and reduced tissue perfusion. It is a common vascular change associated with aging and with conditions such as hypertension and diabetes mellitus. The lesions can be detected in many organs, including the kidneys, brain, retina, and heart.

Hyaline arteriolosclerosis refers to homogeneous, pink hyaline thickening of arteriolar walls due to plasma protein leakage across damaged endothelium and increased smooth muscle cell matrix production. It is classically associated with long-standing essential hypertension and diabetes mellitus, and it contributes to nephrosclerosis and retinopathy.

Hyperplastic arteriolosclerosis features concentric, laminated onion-skin thickening of arteriolar walls with smooth muscle cell hyperplasia and basement membrane duplication. It is most often seen in severe or malignant hypertension and can cause ischemia in the involved organs, including the kidney, brain, and retina; it is frequently accompanied by fibrinoid necrosis.

Other forms include arteriolosclerosis in aging (senile arteriolosclerosis) and amyloid arteriolosclerosis, in which amyloid deposits within the vessel walls contribute to stiffening, often seen in systemic or cerebral amyloidosis and contributing to ischemic risk.

Clinical relevance includes predisposition to lacunar strokes and chronic kidney disease due to nephrosclerosis. Diagnosis is usually histopathologic, often from biopsy or autopsy; imaging and clinical assessment may suggest vascular involvement but are not specific. Management focuses on controlling blood pressure, glucose levels in diabetes, and other vascular risk factors to slow progression and reduce end-organ damage.