Renal artery fibromuscular dyspasia

Introduction: Fibromuscular dysplasia is a nonathe-rosclerotic, noninflammatory arterial disease that pre-dominantly affects the renal arteries but has also been identified in almost every arterial territory. Fibromus-cular dysplasia may cause arterial stenosis, occlusion, aneurysm, dissection, but many patients are likely asymptomatic and may remain undiagnosed. The most common manifestation of renal artery fibromuscular dysplasia is hypertension caused by renal artery ste-nosis activating the renin-angiotensin-aldosterone axis. Angiography remains the most accurate imaging technique to diagnose and evaluate fibromuscular dys-plasia. In patients in whom high blood pressure is ne-wly diagnosed and secondary to renal artery fibromus-cular dysplasia, the initial treatment may be percutane-ous balloon angioplasty.
Case presentation: We present a case of hypertension in a 38 year old woman who was diagnosed with reno-vascular hypertension due to fibromuscular dysplasia of the right renal artery. Renal scintigraphy showed a small right kidney which was suggested to be either congenital or due to renal artery stenosis, with slightly altered perfusion and function. Tomography revealed significant renal artery stenosis, suggesting fibromuscular dysplasia. Angiography confirmed right renal artery stenosis and slight intra-luminal irregularity of the left renal artery. Stenotic lesion of the renal artery was treated by balloon angioplasty.
The evolution of the patient improved after the pro-cedure, both from the clinical point of view (control-led blood pressure, below 130/80 mmHg) as well as the blood tests (normal ionogram and kidney function). Two weeks after discharge, the patient’s blood pressu-re was monitored with a 24 hours Holter that showed values below 130/80mmHg, under a treatment with ACEIs and double platelet antiaggregant, without any additional antihypertensive treatment. A periodic mo-nitoring was recommended while aiming to follow the evolution of the left renal artery lesions as well as the eventual recurrence of the right renal artery stenosis. Conclusions: Fibromuscular dysplasia causing renal artery stenosis, though a rare cause of renovascular hypertension is essential to be considered in young hypertensives, even in the absence of family history of hypertension. A high index of suspicion is necessary in early diagnosis and prompt treatment, which would re-sult in rapid and complete recovery.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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