Background Fibromuscolar dysplasia (FMD) is an idiopathic, non-atherosclerotic and non-inflammatory stenotic lesion of renal arteries causing
renovascular hypertension up-regulating renin-angiotensin-aldosterone system. Case report: A 18-year-old man was referred to our
Hypertension Center (Clinica e Terapia Medica) for the recent onset of
hypertension, poorly controlled on
calcium channel blockers, already associated to electrocardiographic and echocardiography signs of
left ventricular hypertrophy and significant
albuminuria (728 mg/24 h). An increased plasma
renin activity (PRA),
aldosterone level and a mild
hypokalemia raised the suspicion of
renovascular hypertension. Abdominal CT and MRI angiography showed mild kidneys asymmetry and a tubular
stenosis of the right renal artery in its mid-distal portion close to renal hilum.
Radionuclide renal scintigraphy documented a kidneys asymmetry of separated glomerular filtration rate. Renal FMD was diagnosed based on patient age and the absence of cardiovascular risk factors for
atherosclerosis. Patient successfully underwent right renal angioplasty giving a rapid normalization of blood pressure levels without
antihypertensive drugs. Plasma
aldosterone and PRA rapidly normalized as well as serum
potassium levels. Six months after angioplasty echocardiography showed a regression of
left ventricular hypertrophy and the patient
albumin urine excretion became normal (14 mg/24 h). Conclusions FMD can cause
renovascular hypertension associated to organ damage such myocardial
hypertrophy and
albuminuria through mechanisms dependent but also independent from blood pressure levels. Renal angioplasty turned off
renin-
angiotensin-
aldosterone overactivity allowing the cure the
hypertension and a surprisingly rapid reverse of myocardial
hypertrophy and of excess of
albumin urine excretion not only dependent on blood pressure normalization.