Abstract. Background: Fibromuscolar dysplasia (FMD) is an idiopathic, non-atherosclerotic and non-in- flammatory stenotic lesion of renal arteries causing renovascular hypertension up-regulating renin-angioten- sin-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 hypoka- lemia 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 ath- erosclerosis. 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.

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 / Merla, Simona; Simoni, Riccardo; Tedeschi, Stefano; Ferrari, Massimiliano; Passeri, Giovanni; Marcato, Carla; Epifani, Enrico; Semproni, Ignazio; Zini, Giulia; Verzicco, Ignazio; Coghi, Pietro; Volpi, Riccardo; Cabassi, Aderville. - In: ACTA BIOMEDICA. - ISSN 2531-6745. - vol 92:Supplement 1: e2021162(2021), pp. 1-9. [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;Riccardo Simoni;Stefano Tedeschi;Massimiliano Ferrari;Giovanni Passeri;Enrico Epifani;Ignazio Semproni;Ignazio Verzicco;Riccardo Volpi;Aderville Cabassi.
2021

Abstract

Abstract. Background: Fibromuscolar dysplasia (FMD) is an idiopathic, non-atherosclerotic and non-in- flammatory stenotic lesion of renal arteries causing renovascular hypertension up-regulating renin-angioten- sin-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 hypoka- lemia 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 ath- erosclerosis. 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.
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 / Merla, Simona; Simoni, Riccardo; Tedeschi, Stefano; Ferrari, Massimiliano; Passeri, Giovanni; Marcato, Carla; Epifani, Enrico; Semproni, Ignazio; Zini, Giulia; Verzicco, Ignazio; Coghi, Pietro; Volpi, Riccardo; Cabassi, Aderville. - In: ACTA BIOMEDICA. - ISSN 2531-6745. - vol 92:Supplement 1: e2021162(2021), pp. 1-9. [10.23750/abm.v92iS1.9358]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11381/2893574
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