Related Experiment Video
Updated: Jan 25, 2026
Direct Drug Delivery to Kidney via the Renal Artery
Published on: April 17, 2021
Challenges in diagnosing and treating a patient with renal artery fibromuscular dysplasia: case report
Julio César Rodríguez Goyes1, Nicolás Ignacio Jaramillo Gómez2
1Internal Medine, Clínica Las Américas, Medellín (Antioquia), Colombia.
Insights
Resistant hypertension in a patient was successfully treated by identifying and performing angioplasty for bilateral renal artery fibromuscular dysplasia (FMD). This case highlights FMD as a potential cause of difficult-to-manage high blood pressure.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Radiology
Background:
- Presents a case of a 40-year-old female with a history of sinus venous thrombosis and uncontrolled hypertension.
- Hypertension persisted despite multiple antihypertensive medications, diet, and exercise, indicating resistant hypertension.
Observation:
- Patient presented with diastolic blood pressure over 100 mmHg despite treatment with verapamil, losartan, and hydrochlorothiazide.
- Routine investigations including labs and echocardiogram were normal.
- Renal angio-CT revealed bilateral fibromuscular dysplasia (FMD).
Findings:
- Renal artery angioplasty with balloon was performed, resulting in excellent blood pressure control.
- Antihypertensive medication was reduced to two drugs at intermediate doses post-procedure.
- The patient became asymptomatic with improved blood pressure management.
Implications:
- Renal artery fibromuscular dysplasia (FMD) can be a difficult diagnosis and a cause of resistant hypertension.
- Angioplasty is an effective treatment for symptomatic and resistant hypertension due to FMD.
- Highlights the importance of considering FMD in patients with unexplained resistant hypertension, even with normal initial tests.
Background:
We present a patient with history of sinus venous thrombosis and hypertension during the last year. Her blood pressure was not controlled despite drugs, diet, and exercise. She denied symptoms. She does not smoke nor drink alcohol. Her body mass index was 20 kg/m2, NYHA Class I/IV.
Case Summary:
A 40-year-old Latin-American female patient, concerned because despite taking verapamil 160 mg/day, losartan 100 mg/day, and hydrochlorothiazide 25 mg/day her diastolic blood pressure was over 100 mmHg. Routine serum and urine lab tests and a transthoracic echocardiogram were done and were normal. The treatment was increased over the next consultations but without control of her blood pressure. She developed resistant hypertension, and she was taking four antihypertensive drugs and two diuretics. A first renal artery Doppler was normal. Because of a high clinical suspicion a renal angio-CT was performed showing bilateral fibromuscular dysplasia. The patient underwent a renal artery angioplasty with balloon with excellent results and better control of her blood pressure after the procedure. Over the next month, her doctors were able to decrease her treatment to two drugs at intermediate doses. Currently, she is doing well and asymptomatic.
Discussion:
Renal artery fibromuscular dysplasia (FMD) could be a challenging disease to be diagnosed. Patients with this condition may suffer from symptomatic and resistant hypertension. Many patients do not have abnormalities on their physical exam or in the routine lab tests. Treatment includes renal artery angioplasty if patient is symptomatic and blood pressure is resistant.
Related Concept Videos
01:24Diagnosing Acidosis and Alkalosis
First, the pH level is assessed to determine whether the blood pH is normal (7.35–7.45), low (acidosis), or high (alkalosis).
Next, the PCO2 and...
01:24Data Reporting and Recording
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:25Types of Reports I: Hands-off Report
Following are the key components and categories of hand-off reports:
Purpose and Process:
01:20Renal Corpuscle
Glomerulus: Structure and Function
The glomerulus is a tiny, intricate network of capillaries located at the beginning of the nephron. It's enveloped by the Bowman's capsule and receives its blood supply from an afferent arteriole, which divides into numerous...
01:23Renal Clearance
Renal clearance refers to the volume of plasma cleared of a specific substance, such as creatinine, per unit of time. To measure clearance, urine samples are collected over a 24-hour period during each bladder voiding, followed by a single blood sample at the...