Renal artery fibromuscular dysplasia and its effect on the kidney

Fibromuscular dysplasia is a heterogeneous group of systemic, noninflammatory, and nonatherosclerotic diseases of the vascular wall. It is the second-most common abnormality of the renal artery. Although hypertension is the most common presenting symptom, other symptoms, such as pulsatile tinnitus, stroke, chest pain, or abdominal discomfort, may result from other affected vascular beds. Revascularization of the renal artery appears to be effective at lowering blood pressure in many patients with renal artery fibromuscular dysplasia. For a long time, the intrarenal pathophysiological changes and mechanisms leading to hypertension had hardly been studied in patients with renal artery fibromuscular dysplasia. Recent data, however, has provided more insight into the effects of renal artery fibromuscular dysplasia on the intrarenal microvasculature and the intra-renal renin-angiotensin system in these patients. Moreover, these data have changed our view of the pathophysiological mechanisms leading to hypertension in patients with renal artery fibromuscular dysplasia. In this review, we will discuss recent clinical and scientific developments regarding renal artery fibromuscular dysplasia with an emphasis on its effects on the kidney.