title: Bilateral renal infarctions complicating fibromuscular dysplasia of renal arteries in a young male.
abstract: Fibromuscular dysplasia (FMD) is an uncommon disorder, accounting for less than 10% of cases of renal artery stenosis, and typically presenting with hypertension in young women. This article reports the case of a previously healthy 37-year-old man presenting with acute-onset, severe, bilateral flank pain. Initially treated for ureteral colic and urinary tract infection, he was transferred to the nephrology clinic upon recognition of a rising serum creatinine. He was found to have FMD of bilateral renal arteries with a stenotic pattern on the right side and a dissecting aneurysm on the left side with resultant infarctions in both kidneys. On the basis of negative serological markers of vasculitis, a diagnosis of FMD complicated by bilateral renal infarctions was made. A stent was placed to the right stenotic renal artery, which resulted in sufficient lumen patency. No invasive procedure was performed on the other side owing to the complexity of the lesion. After 2.5 years of follow-up, the patient remained in good condition with normal renal function and adequate blood pressure control with dual antihypertensive therapy. Renal infarction complicating FMD of renal arteries is rare in the literature, with most of the cases having causative cardiovascular risk factors including coagulopathy, ischaemic heart disease, atrial fibrillation or structural cardiac abnormalities, none of which was present in this case. In conclusion, FMD may occur in atypical asymmetric presentations causing renal infarctions in both kidneys. Radiological interventions in such cases should focus on stabilizing renal lesions and renal function.
authors.affiliation: Department of Internal Medicine, Division of Nephrology, Pamukkale University, Medical School, Denizli, Turkey. belda1@yahoo.com
authors.forename: Belda
authors.initials: B
authors.lastname: Dursun
authors.forename: Baki
authors.initials: B
authors.lastname: Yagci
authors.forename: Mehmet
authors.initials: M
authors.lastname: Batmazoglu
authors.forename: Gokcen
authors.initials: G
authors.lastname: Demiray
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D000792:Angiography; D005352:Fibromuscular Dysplasia / Q000150:complications*; D005500:Follow-Up Studies; D006801:Humans; D007238:Infarction / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000628:therapy; D007668:Kidney / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D012077:Renal Artery / Q000000981:diagnostic imaging* / Q000473:pathology; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome