Hypertension Journal

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Fibromuscular Dysplasia of Renal Artery
  JOHTN
IMAGES IN HYPERTENSION
Fibromuscular Dysplasia of Renal Artery
Kakarla S Rao
Chairman
KIMS Foundation Research Centre, Krishna Institute of MedicalSciences, Secunderabad, Telangana, India
Correspondence: Kakarla S Rao, Chairman, KIMSFoundation Research Centre, Krishna Institute of Medical SciencesSecunderabad, Telangana, India
Phone: +9104023563155
e-mail: subbaraokakarla25@gmail.com
 
ABSTRACT
Fibromuscular dysplasia (FMD) of the renel artery is one of theetiological factors of secondary hypertension. The etiology isunknown. Conventional radiography is ideal when interventionalmethods are planned. The beaded appearance is the typicalappearance of FMD on angiogram.
Keywords: Fibromuscular dysplasia, Idiopathic, Nonatherosclerotic.
How to cite this article: Rao KS. Fibromuscular Dysplasia ofRenal Artery. Hypertens J 2016;2(2):103-104.
Source of support:Nil
Conflict of interest: None
 
 
INTRODUCTION

A 35-year-old female was diagnosed with new-onset hypertension.Due to significant elevation in blood pressureand her age, the possibility of "secondary" hypertensionwas considered.1,2 Work-up revealed unilateral right renalartery stenosis due to fibromuscular dysplasia (FMD). Theangiogram shown in Figure 1 is the typical appearance ofFMD. For reasons not firmly known, FMD is more commonin women than in men. Hormonal etiology may be afactor but not established. Fibromuscular dysplasia of renalarteries should be suspected in women with new onset orsevere hypertension. The condition responds favorably topercutaneous transluminal angioplasty.3-5

Fibromuscular dysplasia is an idiopathic, segmental,noninflammatory and nonatherosclerotic disease that canaffect all layers of both small and medium caliber arteries.The exact etiology is not known and the pathophysiologyis vague. This occurs predominantly in young womenof child-bearing age and is often unilateral. It may befamilial. Routine laboratory investigations are usuallynonproductive, but in long-standing cases, renal impairmentmay be noted. Pathologically, FMD is classifiedinto three main types: Intimal, medial, and adventitial.Conventional radiography may not be helpful. Color ultrasonography is helpful but it is not good for management.Computed tomography and magnetic resonanceimaging are quite helpful. Conventional angiography isideal in case interventional methods are to be adopted.3,6-8

  Fibromuscular Dysplasia of Renal Artery
Fig. 1: Typical appearance of FMD

REFERENCES
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  2. Olin JW, Gornik HL, Bacharach JM, Biller J, Fine LJ,Gray BH, Gray WA, Gupta R, Hamburg NM, Katzen BT,et al. Fibromuscular dysplasia: state of the science andcritical unanswered questions: a scientific statement from theAmerican Heart Association. Circulation 2014 Mar 4;129(9):1048-1078.
  3. Savard S, Steichen O, Azarine A, Azizi M, Jeunemaitre X,Plouin PF. Association between 2 angiographic subtypesof renal artery fibromuscular dysplasia and clinicalcharacteristics. Circulation 2012 Dec 18;126(25):3062-3069.
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  5. Olin JW, Froehlich J, Gu X, Bacharach JM, Eagle K, Gray BH,Jaff MR, Kim ES, Mace P, Matsumoto AH, et al. The UnitedStates Registry for Fibromuscular Dysplasia: results inthe first 447 patients. Circulation 2012 Jun 26;125(25):3182-3190.

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Kakarla S Rao

  1. Luscher TF, Keller HM, Imhof HG, Greminger P, Kuhlmann U,Largiader F, Schneider E, Schneider J, Vetter W. Fibromuscularhyperplasia: extension of the disease and therapeuticoutcome. Results of the University Hospital Zurich CooperativeStudy on Fibromuscular Hyperplasia. Nephron 1986;44(Suppl 1):109-114.
 
  1. Olin JW, Pierce M. Contemporary management of fibromusculardysplasia. Curr Opin Cardiol 2008 Nov;23(6):527-536.
  2. 8. Trinquart L, Mounier-Vehier C, Sapoval M, Gagnon N, Plouin PF.Efficacy of revascularization for renal artery stenosis causedby fibromuscular dysplasia: a systematic review and metaanalysis.Hypertension 2010 Sep;56(3):525-532.
 
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