Introduction:
Fibromuscular dysplasia (FMD) is a noninflammatory, nonatherosclerotic disorder that causes arterial stenosis, occlusion, aneurysm, dissection, and arterial tortuosity. These findings have been observed in nearly all arterial beds. The most frequently affected arteries are the renal and internal carotid arteries, followed by the vertebral, visceral, and external iliac arteries. The presentation of the disease can vary widely, depending on the arterial segment affected and the severity of the disease.
Methods:
Report a clinical case of hospital in Santiago, Chile
Results:
We present the case of a 47-year-old female patient with a history of difficult-to-control arterial hypertension who came to the emergency room with a 3-day history of vomiting, epigastric abdominal pain, and poor general condition. She was admitted with elevated blood pressure 226/120, with oxygen requirements fraction of inspired oxygen 50%, heart rate 80 beats per minute, temperature 36ºC, laboratory tests showed serum creatinine 8 mg/dL, blood urea nitrogen 160 mg/dL, sodium 131 mEq/L, K+ 5.4 mEq/L, chlorine 110 mEq/L, phosphorus 5.8 mg/dL, calcium 8.2 mg/dL, albumin 3.8 mg/dL. She was admitted to the ICU in serious condition, connected to mechanical ventilation, and emergency hemodialysis was performed through a temporary access. In the study of chronic kidney disease, the patient had a 24-hour proteinuria of 550 mg/day, with no elements in the complete urine, absence of hematuria, leukocyturia and cylinders. In the renal ultrasound, the right kidney measured 8.2 cm and the left 11.6 cm with an adequate relationship between cortex and medulla without lithiasis or hydronephrosis. An abdominal CT scan with contrast was also performed, which showed critical stenosis of the right renal artery associated with ipsilateral renal atrophy, mild stenosis in the left renal artery, decreasing flow. The patient has evolved with hemodialysis requirements, and resolution of left renal stenosis is proposed with a stent implanted by percutaneous vascular surgery, although the date of presentation of this clinical case is still pending.
Conclusions:
Fibromuscular dysplasia is a rare cause of renovascular hypertension, predominant in women in the 4th decade. Its diagnosis is mainly angiographic, since histology is rarely available. Its main angiographic characteristic is string of beads, which are usually caused by multiple stenosis. Less frequent is the single stenosis of a vessel. Its management consists mainly of endovascular therapy by installing a stent at the site of stenosis. There is also surgical management, the main surgery being the performance of an aorto-renal bypass with a native vein or prosthetic material. The diagnosis of this pathology is a challenge, and some clues may be hypertension with hypokalemia and auscultation of murmurs in the flanks.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.