title: A patient with acute kidney pain and high blood pressure.
abstract: This case presented challenging diagnostic and management issues in a young healthy man who presented with abdominal pain and new-onset hypertension. The differential diagnosis evolved over the course of the clinical presentation. The patient had severe vascular involvement of his renal and basal cerebral arteries that initially was assumed to be due to a vasculitic process or hypercoagulable state. Finally it became apparent that the patient did not have a systemic illness but rather a localized vascular disease most likely due to segmental arterial mediolysis, a rare, under-recognized condition that can potentially be fatal. This condition is often difficult to distinguish from fibromuscular dysplasia. It is important to recognize and correctly diagnose the condition, particularly in the acute phase of the disease, because delay in diagnosis can contribute to morbidity and mortality.
authors.affiliation: Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and debbie.cohen@uphs.upenn.edu.
authors.forename: Debbie L
authors.initials: DL
authors.lastname: Cohen
authors.affiliation: Division of Interventional Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Soulen
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D059787:Acute Pain / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D000328:Adult; D015901:Angiography, Digital Subtraction; D017130:Angioplasty; D000925:Anticoagulants / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001706:Biopsy; D001794:Blood Pressure / Q000187:drug effects; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D003937:Diagnosis, Differential; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D011237:Predictive Value of Tests; D012078:Renal Artery Obstruction / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D000959:Antihypertensive Agents
keywords: clinical hypertension; hypertension; renal; renal artery stenosis; vascular disease