Cause of secondary arterial hypertension – renal artery fibromuscular dysplasia

Introduction: Renal artery fibromuscular dysplasia is a non-atherosclerotic, non-inflammatory condition, characterized by media fibrodisplazia, being the second leading cause of reno-vascular hypertension. We present the case of a patient aged 25, smoking (6 years), with known hypertension (SBP max. = 250 mm Hg), no other significant pathological personal history, presenting for headache and vertigo, occurring a week ago. Methods: Clinical examination revealed BP = 260/130 mm Hg, left paraombilical systolic murmur. Biological: mild nitrogen retention registers syndrome, urinalysis with leucocyturia and traces of protein. ECG – without significant changes. Holter BP: systolic values consistently above 160 mm Hg, with SBP max. = 223 mm Hg. Abdominal ultrasound – left kidney size decrease compared to the right kidney. Arterial Doppler ultrasound examination of the left renal artery showed increased fl ow velocities. Renal artery arteriography revealed origin of the left renal artery without lesions, ~ 70 – 80% stenosis, serial, fibromuscular dysplasia looking at the middle segment and the right renal artery were normal. Fundus exam – grade II hypertensive retinopathy. Results: Treated with calcium channel blocker and angioplasty balloon of the left renal artery, the subsequent evolution is favorable, back pressure values within normal limits. Conclusions: In such cases, angioplasty balloon success exceeds 90%, and long-term prognosis is generally favorable, mainly conditioned by the control of cardiovascular risk factors.

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)