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Case Reports
. 2021 Apr 30;92(S1):e2021162.
doi: 10.23750/abm.v92iS1.9358.

High renin hypertension in focal renal fibromuscular dysplasia: turn off of renin system angiotensin overactivation by renal angioplasty cured high blood pressure and quickly reversed myocardial hypertrophy

Simona Merla  1 , Riccardo Simoni  2 , Stefano Tedeschi  3 , Massimiliano Ferrari  4 , Giovanni Passeri  5 , Carla Marcato  6 , Enrico Epifani  7 , Ignazio Semproni  8 , Giulia Zini  9 , Ignazio Verzicco  10 , Pietro Coghi  11 , Riccardo Volpi  12 , Aderville Cabassi  13
Affiliations
Case Reports

High renin hypertension in focal renal fibromuscular dysplasia: turn off of renin system angiotensin overactivation by renal angioplasty cured high blood pressure and quickly reversed myocardial hypertrophy

Simona Merla et al. Acta Biomed. .

Abstract

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.

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Conflict of interest statement

Each author declares that she or he has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangement etc.) that might pose a conflict of interest in connection with the submitted article

Figures

Figure 1.
Figure 1.
Patient’s baseline electrocardiogram recording (A) showing sinus rhythm at 67 beats/minutes, with normal intervals and mean QRS axis. Sokolow-Lyon voltage criteria for left ventricular hypertrophy are met in the precordial leads (sum of S wave in V2 and R wave in V6 = 4,3 mV); six months after renal angioplasty, the electrocardiographic recording (B) showed a markedly attenuation of the left ventricular hypertrophy criteria (sum of S wave in V2 and R wave in V6 = 3,3 mV).
Figure 2.
Figure 2.
Upper abdominal CT Scan with contrast injection (A) and Magnetic Resonance Imaging (B) showing a narrowing of medium-distal portion of the right renal artery and (C) kidneys asymmetry.
Figure 3.
Figure 3.
Right renal Angiography before (A) and after (B) balloon angioplasty.
See this image and copyright information in PMC

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