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      Bilateral renal infarction: an uncommon presentation of fibromuscular dysplasia

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      Author(s): ,
      Publication date PMC-release:
      Journal: Clinical Kidney Journal
      Publisher: Oxford University Press
      Keywords: fibromuscular dysplasia, hypertension, renal infarction

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          Abstract

          While fibromuscular dysplasia (FMD) is an established cause of secondary hypertension, its association with renal infarction is less well recognized. We report a middle-aged man who presented with complaints of loin pain and severe hypertension. Computed tomography angiography of the abdomen revealed bilateral renal infarction with multiple short-segment arterial dissection compatible with FMD in the absence of systemic vasculitis and other risk factors for thromboembolic events. Bilateral renal infarction complicating FMD is extremely rare and has so far been reported only in a handful of cases. Physicians encountering cases of otherwise unexplained renal infarction/ischemia need to be aware of this complication.

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          Most cited references17

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          Fibromuscular dysplasia.

          Ilana W. Olin, D Slovut (2004)
          Article 0 comments Cited 99 times – based on 0 reviews     Review now
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            Acute renal infarction. Clinical characteristics of 17 patients.

            G Meron, M Nikfardjam, A Laggner … (1999)
            We analyzed the medical records of patients with an established diagnosis of acute renal infarction to identify predictive parameters of this rare disease. Seventeen patients (8 male) who were admitted to our emergency department between May 1994 and January 1998 were diagnosed by contrast-enhanced computed tomography (CT) as having acute renal infarction (0.007% of all patients). We screened the records of the 17 patients for a history with increased risk for thromboembolism, clinical symptoms, and urine and blood laboratory results known to be associated with acute renal infarction. A history with increased risk for thromboembolism with 1 or more risk factors was found in 14 of 17 patients (82%); risk factors were atrial fibrillation (n = 11), previous embolism (n = 6), mitral stenosis (n = 6), hypertension (n = 9), and ischemic cardiac disease (n = 7). All patients reported persisting pain predominantly from the flank (n = 11), abdomen (n = 4), and lower back (n = 2). On admission, elevated serum lactate dehydrogenase was found in 16 (94%) patients, and hematuria was found in 12 (71%) of 17 patients. After 24 hours all patients showed an elevated serum lactate dehydrogenase, and 14 (82%) had a positive test for hematuria. Our findings suggest that in all patients presenting with the triad--high risk of a thromboembolic event, persisting flank/abdominal/lower back pain, elevated serum levels of lactate dehydrogenase and/or hematuria within 24 hours after pain onset--contrast-enhanced CT should be performed as soon as possible to rule out or to prove acute renal infarction.
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              Diagnosis, management, and future developments of fibromuscular dysplasia.

              Ilana W. Olin, Brett A Sealove (2011)
              Fibromuscular dysplasia (FMD) is a nonatherosclerotic noninflammatory vascular disease that primarily affects women from age 20 to 60, but may also occur in infants and children, men, and the elderly. It most commonly affects the renal and carotid arteries but has been observed in almost every artery in the body. FMD has been considered rare and thus is often underdiagnosed and poorly understood by many health care providers. There are, however, data to suggest that FMD is much more common than previously thought, perhaps affecting as many as 4% of adult women. When it affects the renal arteries, the most common presentation is hypertension. When it affects the carotid or vertebral arteries, the patient may present with transient ischemic attack or stroke, or dissection. An increasing number of patients are asymptomatic and are only discovered incidentally when imaging is performed for some other reason or by the detection of an asymptomatic bruit. FMD should be considered in the differential diagnosis of a young person with a cervical bruit; a "swishing" sound in the ear(s); transient ischemic attack, stroke, or dissection of an artery; or in individuals aged ≤ 35 years with onset hypertension. Treatment consists of antiplatelet therapy for asymptomatic individuals and percutaneous balloon angioplasty for patients with indications for intervention. Patients with aneurysms should be treated with a covered stent or open surgical repair. Little new information has been published about FMD in the last 40 years. The recently instituted International Registry for Fibromuscular Dysplasia will remedy that situation and provide observational data on a large numbers of patients with FMD. Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Kidney J
                Journal ID (iso-abbrev): Clin Kidney J
                Journal ID (publisher-id): ckj
                Journal ID (hwp): ndtplus
                Title: Clinical Kidney Journal
                Publisher: Oxford University Press
                ISSN (Print): 2048-8505
                ISSN (Electronic): 2048-8513
                Publication date (Print): December 2013
                Publication date PMC-release: December 2013
                Volume: 6
                Issue: 6
                Pages: 646-649
                Affiliations
                Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida , Gainesville, FL, USA
                Author notes
                Correspondence and offprint requests to: Amir Kazory; E-mail: amir.kazory@ 123456medicine.ufl.edu
                Article
                Publisher ID: sft133
                DOI: 10.1093/ckj/sft133
                PMC ID: 4438380
                SO-VID: 4a56394f-c4ef-48a0-86f3-69a3f111f0f3
                Copyright © © The Author 2013. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For permissions, please email: journals.permissions@oup.com.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Date received : 23 September 2013
                Date accepted : 30 September 2013
                Page count
                Pages: 4
                Categories
                Subject: Clinical Cases
                Subject: Clinical Reports

                ScienceOpen disciplines: Nephrology
                Keywords: fibromuscular dysplasia,hypertension,renal infarction
                Data availability:
                ScienceOpen disciplines: Nephrology
                Keywords: fibromuscular dysplasia, hypertension, renal infarction

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