A case of treatable hypertension: fibromuscular dysplasia of renal arteries

Dissanayake Mudiyanselage Priyantha Ralapanawa, Kushalee Poornima Jayawickreme, Ekanayake Mudiyanselage Madhushanka Ekanayake

Renovascular hypertension accounts for 51-52 % of all cases of hypertension in the general population, but plays a major role in treatable causes for hypertension in the young. This entity consists of renal vascular atherosclerosis (90 %), commonly seen among the elderly population, and renal fibro muscular dysplasia (FMD) (10 %), predominantly seen in the young. The prevalence of clinically significant renal artery fibromuscular dysplasia is 0.4 %. We present a case of treatable young hypertension in a 29 year old female, who was diagnosed with renovascular hypertension due to fibromuscular dysplasia of the left renal artery. Computed tomographic angiogram revealed significant stenosis of the left main renal artery. Diethylene triamine penta acetic acid renogram showed a small left kidney due to renal artery stenosis. She underwent left sided nephrectomy, and histology revealed features of FMD, after which she achieved full recovery with normalization of blood pressure, and did not require antihypertensive drug treatment. Fibromuscular dysplasia causing renal artery stenosis, though a rare cause of renovascular hypertension, is essential to be considered in young hypertensives, even in the absence of family history of hypertension. A high index of suspicion is necessary in early diagnosis and prompt treatment, which can result in rapid and complete recovery.