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Fibromuscular dysplasia presenting as a renal infarction: a case report
Annelies Van den Driessche1, Erik Van Hul, Malika Ichiche
1Department of Nephrology-Hypertension, Antwerp University Hospital, Edegem (Antwerpen), Belgium. jeanlouis.bosmans@ua.ac.be.
Insights
Fibromuscular dysplasia, a rare cause of renal infarction, commonly affects young adults and can lead to renovascular hypertension. Early diagnosis and treatment, including angioplasty, are crucial for managing this curable condition.
Area of Science:
- Vascular Medicine
- Nephrology
- Radiology
Background:
- Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory arterial disease.
- It predominantly affects the renal and internal carotid arteries.
- FMD is a leading cause of secondary hypertension in individuals under 50.
Purpose of the Study:
- To present a rare case of FMD presenting as renal infarction.
- To highlight the diagnostic findings and management of FMD.
- To emphasize the importance of considering FMD in young hypertensive patients.
Main Methods:
- Case report of a 44-year-old male with loin pain and hypertension.
- Diagnostic imaging included computed tomography (CT) scan and renal angiography.
- Treatment involved oral anticoagulation and antihypertensive medications.
Main Results:
- CT revealed right renal infarction and a nodular right renal artery.
- Renal angiography demonstrated the characteristic 'string of beads' pattern.
- Hypertension was controlled with medication; angioplasty was declined.
Conclusions:
- Renal infarction is an uncommon presentation of FMD.
- FMD is a significant cause of curable renovascular hypertension.
- Percutaneous transluminal renal angioplasty may offer advantages over medication for certain FMD indications.
Introduction:
Fibromuscular dysplasia is a non-atherosclerotic, non-inflammatory disease that most commonly affects the renal and internal carotid arteries.
Case Presentation:
We present the case of a 44-year-old Caucasian man who was admitted with complaints of loin pain and hypertension. A computed tomography scan of the abdomen revealed a right renal infarction with a nodular aspect of the right renal artery. Subsequent renal angiography revealed a typical 'string of beads' pattern of the right renal artery with thrombus formation. Oral anticoagulation was started and the secondary hypertension was easily controlled with anti-hypertensive drugs. At follow-up, our patient refused percutaneous transluminal renal angioplasty as a definitive treatment.
Conclusions:
Fibromuscular dysplasia is the most common cause of renovascular hypertension in patients under 50 years of age. Presentation with renal infarction is rare.In fibromuscular dysplasia, angioplasty has been proven to have, at least for some indications, an advantage over anti-hypertensive drugs. Therefore, hypertension secondary to fibromuscular dysplasia is the most common cause of curable hypertension.
