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NBME 22 Answers
A 53-year-old woman with a long history of ...
I had a similar thought regarding mesangial hypercellularity. I missed a UW question on a similar topic. Unilateral renal artery stenosis results in hyperplasia of modified smooth muscle cells (JG cells) due to reduced RBF. The hyperplasia is intended to correct the supposed deficiency via increased production of renin.
Kidney is smaller than normal, suggesting less blood flow to it. Won't see shrunken kidney in the case of HTN.