Resistant Hypertension due to Fibromuscular Dysplasia in a Young Male: A Rare Case Report

Abstract

Fibromuscular Dysplasia (FMD) is a sporadic non-atherosclerotic disease. FMD has been established in nearly every arterial bed. However, the most frequent arteries affected are the renal and carotid arteries. Disease presentation may vary broadly, depending upon the arterial bed complication and the severity of illness. Hypertension, particularly resistant type, headache and dizziness are the most common presentations. String of beads appearance in angiographic views due to post-stenotic aneurysms is the characteristic view. It is most commonly described in young aged females; but in rare male cases has also been reported. Moreover, balloon angioplasty is standard and effective therapy for FMD. We present a young 28-year-old man who was referred for evaluation of resistant hypertension for nearly 3 years without comprehensive workup. The patient underwent renal artery angiography which confirmed beading narrowing of the right renal artery with significant stenosis at mid portion compatible with FMD; and balloon angioplasty was done. This case highlights that FMD should be kept in mind as a rare cause of resistant hypertension in young males; although it is most common in young females.

A Rare Case of Focal Renal Fibromuscular Dysplasia Treated With Angioplasty: A Case Report

“…Even though atherosclerotic RAS is more common than FMD, it is important to rule out other possible diagnoses, such as FMD, which is a rare cause of RAS that could easily be missed. 3 Our patient had nearly three years of uncontrolled hypertension without a comprehensive evaluation. In our case, the diagnosis was made by CT angiography.…”

“…The two most common renal artery diseases that can result in resistant hypertension are atherosclerotic renal artery stenosis (RAS) and FMD. 3 FMD was first described by Leadbetter et al in 1938. 4 FMD is a rare, idiopathic, non-atherosclerotic, non-inflammatory disorder that results in narrowing of small and medium-sized arteries.…”

“…2,6 Maybe because our case was early diagnosed and had not yet developed chronic parenchymal kidney disease as a complication of FMD, compared to those in the literature, in which most cases have resistant hypertension and/or renal impairment. 3,4,8,9 The re-stenosis of renal arteries are common in FMD with repeated angiography sometime are needed. 2,9 A previous study of 15 patients show a cure rate of 80%, with re-stenosis in four patients during follow-up.…”

“…The two most common renal artery diseases that can result in resistant hypertension are atherosclerotic renal artery stenosis (RAS) and FMD. 3…”

“…Even though atherosclerotic RAS is more common than FMD, it is important to rule out other possible diagnoses, such as FMD, which is a rare cause of RAS that could easily be missed. 3…”