[Case of fibromuscular dysplasia revealed by the emergence of severe hypertension in the early phase of pregnancy].
A 25-year-old female at 10 weeks of her first pregnancy abruptly developed severe hypertension as high as 230/160 mmHg and thus was referred to our hospital. Her past history was unremarkable and no medication or supplement was prescribed. The laboratory findings revealed that plasma renin activity was 59.0 ng mL hr and plasma aldosterone concentration was 1700 pg mL together with serum creatinine of 0.42 mg dL and serum potassium of 2.8 mEq L. Urinalysis revealed insignificant findings. Her hypertension was extremely resistant to antihypertensive agents, including hydralazine, alpha-methyldopa, and alpha beta blocker, leading to suspicion of secondary hypertension as a cause. Adrenal tumor was not detected but Doppler ultrasonography suggested the constriction of the right renal artery consistent with renovascular hypertension. Considering the following imaging test and medications, the patient and her family decided to abort the pregnancy. 3D-CT and MR angiography showed stenosis of the right renal artery, therefore, percutaneous transcatheter renal angioplasty was performed, resulting in normalization of the blood pressure without antihypertensives. Two years later she successfully gave birth uneventfully. Her hypertension was presumably irrelevant to preeclampsia because it occurred at 10 weeks of pregnancy and proteinuria was not associated. The stenosis of the right renal artery was probably due to fibromuscular dysplasia, which is one of the major causes of renal artery stenosis in young women. This patient was such a case and presented a difficult decision on how to treat and whether or not to abort. We will discuss the mechanism of hypertension in pregnancy and the advantages and disadvantages of available treatments for such cases.
Arai
Shigeyuki
S
Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.
Akimoto
Hiromasa
H
Tamura
Yoshifuru
Y
Nakajima
Hideaki
H
Kojima
Kenichiro
K
Uchida
Shunya
S
D000328:Adult; D017130:Angioplasty; D003952:Diagnostic Imaging; D005260:Female; D005352:Fibromuscular Dysplasia / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000209:etiology*; D012077:Renal Artery / Q000601:surgery; D012720:Severity of Illness Index