Abstract
BackgroundRenovascular hypertension is defined as hypertension caused by renal artery stenosis. The two main etiologies are atherosclerosis and fibromuscular dysplasia. Fibromuscular dysplasia in an accessory renal artery as a cause of renovascular hypertension is uncommon.Case presentationIn this report, we present a relatively uncommon case of renovascular hypertension in a 35-year-old female with a history of intractable hypertension as a result of fibromuscular dysplasia involving an accessory renal artery. Selective renal angiography was performed and revealed a single renal artery on the right and two renal arteries supplying the left kidney, upper and lower poles. Selective renal angiography showed the typical fibromuscular dysplasia lesion characterized by its classic "string of beads" appearance, consisting of alternating areas of narrowing and dilatation, located in the middle portion of the lower left renal artery (accessory artery) associated with moderate stenosis. Percutaneous balloon dilatation of the stenotic lesion was successfully performed. Following angioplasty, her blood pressure normalized over a period of several months using a single antihypertensive medication (rather than 3 medications).ConclusionFibromuscular dysplasia in an accessory renal artery can, even though rarely, be responsible for renovascular hypertension. Selective renal angiography is the 'gold standard' test and should be performed when renovascular intervention is contemplated.
Highlights
Renovascular hypertension is defined as hypertension caused by renal artery stenosis
Renovascular hypertension (RVH) is defined as hypertension caused by renal artery stenosis (RAS) and accounts for less than 5% of all cases of hypertension in the general population [1]
We present a case of fibromuscular dysplasia (FMD) involving an accessory renal artery causing intractable hypertension diagnosed by Selective renal angiography (SRA)
Summary
Renovascular hypertension (RVH) is defined as hypertension caused by renal artery stenosis (RAS) and accounts for less than 5% of all cases of hypertension in the general population [1]. The patient denied any family history of hypertension Her physical examination revealed a blood pressure of 150/100 mmHg (multiple readings taken from both arms on different occasions were similar). SRA showed the typical FMD lesion which is characterized by its classic "string of beads" appearance, consisting of alternating areas of narrowing and dilatation, located in the middle portion of the lower left renal artery (accessory artery) associated with moderate stenosis (reduction in luminal diameter greater than 50%) (Figure 1). Percutaneous balloon dilatation of the stenotic lesion (middle portion of the accessory renal artery) was successfully performed (Figure 2) Following angioplasty, her blood pressure normalized over a period of several months using a single antihypertensive medication (atenolol 50 mg once daily), rather than 3 medications. They showed that some of these women had successful pregnancies after revascularization
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