A 56-year-old man comes with a history of coronary artery disease, peripheral vascular disease, and a recent heart attack suddenly develops painless hematuria. He subsequently suffers a massive stroke and expires. The patient’s kidney at autopsy is shown. Which of the following is the most likely diagnosis?
1.Chronic pyelonephritis
2.Cortical abscess
3.Cortical infarct
4.Malignant nephrosclerosis
5.Benign nephrosclerosis
exp:
Renal cortical infarcts are, for the most part, caused by arterial obstruction, and most represent embolization to the interlobar or larger branches of the renal artery. Common sources of emboli include mural thrombi, infected valves, and complicated atherosclerotic plaques. A cross section of the kidney shows a peripheral infarct, characterized by marked pallor extending to the subcapsular surface. Choices 4 and 5 (benign and malignant nephrosclerosis) are vascular disorders that are general rather than localized. Choices 1 and 2 do not cause ischemic lesions.