Fibromuscular dysplasia affecting a two-branched renal artery in a patient with a solitary kidney: case presentation

Abstract

Fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory arterial disease, commonly involving the renal arteries. Here we report a case of a 16-year-old Chinese male who was found to have severe hypertension with proteinuria for 2 years. Computed tomography showed absence of the left kidney and enlargement of the right kidney. Subsequent angiography confirmed the above findings and revealed narrowing of both the upper and lower branches of the right renal artery caused by FMD. These combined lesions are very rare, and individuals affected are at increased risk of renal dysfunction if left untreated. Treatment with percutaneous balloon angioplasty is the first choice in such a patient and usually results in optimal outcomes.

Figure 1

Patient's prior computed tomography scan shows enlarged solitary right kidney with bifurcated right renal artery.

Figure 2

Angiography reveals diffuse narrowing in the distal of the upper branch and local narrowing in the middle of the lower branch (with black arrows indicating the narrowed parts).

Figure 3

Angiography reveals diffuse narrowing in the distal of the upper branch and local narrowing in the middle of the lower branch (with black arrows indicating the narrowed parts).

Figure 4

Percutaneous balloon angioplasty is performed after the initial angiogram to correct the stenotic lesions involving both branches.

Figure 5

Percutaneous balloon angioplasty is performed after the initial angiogram to correct the stenotic lesions involving both branches.

Figure 6

Narrowing is corrected after balloon angioplasty (with black arrows pointing to the original narrowing parts).

Figure 7

Narrowing is corrected after balloon angioplasty (with black arrows pointing to the original narrowing parts).