What histologic finding is most likely to be present in the kidneys of a patient with severe hypertension who died after a stroke?

In the context of severe hypertension and its impact on the kidneys, the presence of hyperplastic arteriolitis is a significant histologic finding to consider. Hyperplastic arteriolitis refers to a specific form of vascular injury characterized by the proliferation of smooth muscle cells in the walls of small arteries and arterioles. This condition arises in response to chronic hypertension and leads to the narrowing of the lumens of these blood vessels.

As hypertension progresses, it can cause significant damage to the renal vasculature, ultimately resulting in ischemia and potential renal failure. The appearance of hyperplastic arteriolitis under histological examination typically shows "onion-skin" changes in the affected vessels due to this concentric smooth muscle proliferation. This finding is an indication of end-organ damage from prolonged hypertension, which aligns well with the patient's history of severe hypertension and the subsequent consequences of stroke.

In contrast, the other choices represent different pathologies that are not directly linked to the acute consequences of chronic hypertension in this context. Amyloidosis involves the deposition of amyloid protein in organs, chronic pyelonephritis relates to recurrent urinary tract infections and scarring, and renal papillary necrosis is typically associated with obstruction or ischemia but not specifically