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      Renal Artery Stenosis in a Young Female without Fibromuscular Dysplasia with Literature Review

      case-report

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          Abstract

          Renal artery stenosis (RAS) is rare in young patients without fibromuscular dysplasia (FMD). RAS is primarily classified as having two major etiologies, namely, atherosclerosis and FMD, with 90% and 10%, respectively. We report a case of a female in her mid 20s who developed hypertension due to RAS with no evidence of FMD or underlying renal dysfunction and underwent successful angioplasty and stenting.

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          Stenting and medical therapy for atherosclerotic renal-artery stenosis.

          Christopher J. Cooper, Timothy P Murphy, Donald E Cutlip … (2014)
          Atherosclerotic renal-artery stenosis is a common problem in the elderly. Despite two randomized trials that did not show a benefit of renal-artery stenting with respect to kidney function, the usefulness of stenting for the prevention of major adverse renal and cardiovascular events is uncertain. We randomly assigned 947 participants who had atherosclerotic renal-artery stenosis and either systolic hypertension while taking two or more antihypertensive drugs or chronic kidney disease to medical therapy plus renal-artery stenting or medical therapy alone. Participants were followed for the occurrence of adverse cardiovascular and renal events (a composite end point of death from cardiovascular or renal causes, myocardial infarction, stroke, hospitalization for congestive heart failure, progressive renal insufficiency, or the need for renal-replacement therapy). Over a median follow-up period of 43 months (interquartile range, 31 to 55), the rate of the primary composite end point did not differ significantly between participants who underwent stenting in addition to receiving medical therapy and those who received medical therapy alone (35.1% and 35.8%, respectively; hazard ratio with stenting, 0.94; 95% confidence interval [CI], 0.76 to 1.17; P=0.58). There were also no significant differences between the treatment groups in the rates of the individual components of the primary end point or in all-cause mortality. During follow-up, there was a consistent modest difference in systolic blood pressure favoring the stent group (-2.3 mm Hg; 95% CI, -4.4 to -0.2; P=0.03). Renal-artery stenting did not confer a significant benefit with respect to the prevention of clinical events when added to comprehensive, multifactorial medical therapy in people with atherosclerotic renal-artery stenosis and hypertension or chronic kidney disease. (Funded by the National Heart, Lung and Blood Institute and others; ClinicalTrials.gov number, NCT00081731.).
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            Atherosclerotic renal artery stenosis--diagnosis and treatment.

            David B Lao, Punit Parasher, Kerry C. Cho … (2011)
            Renal artery stenosis (RAS) is characterized by a heterogeneous group of pathophysiologic entities, of which fibromuscular dysplasia and atherosclerotic RAS (ARAS) are the most common. Whether and which patients should undergo revascularization for ARAS is controversial. The general consensus is that all patients with ARAS should receive intensive medical treatment. The latest randomized clinical trials have increased confusion regarding recommendations for revascularization for ARAS. Although revascularization is not indicated in all patients with ARAS, experts agree that it should be considered in some patients, especially those with unstable angina, unexplained pulmonary edema, and hemodynamically significant ARAS with either worsening renal function or with difficult to control hypertension. A search of the literature was performed using PubMed and entering the search terms renal artery stenosis, atherosclerotic renal artery stenosis, and renal artery stenosis AND hypertension to retrieve the most recent publications on diagnosis and treatment of ARAS. In this review, we analyze the pathways related to hypertension in ARAS, the optimal invasive and noninvasive modalities for evaluating the renal arteries, and the available therapies for ARAS and assess future tools and algorithms that may prove useful in evaluating patients for renal revascularization therapy.
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              Fibromuscular dysplasia.

              Stacey Poloskey, Jeffrey Olin, Pamela Mace … (2012)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Med Insights Cardiol
                Journal ID (iso-abbrev): Clin Med Insights Cardiol
                Journal ID (publisher-id): Clinical Medicine Insights: Cardiology
                Title: Clinical Medicine Insights. Cardiology
                Publisher: Libertas Academica
                ISSN (Electronic): 1179-5468
                Publication date Collection: 2016
                Publication date (Electronic): 28 June 2016
                Volume: 10
                Pages: 99-102
                Affiliations
                [1 ]Seton Hall Internal Medicine Residency Program, Trinitas Regional Medical Center, Elizabeth, NJ, USA.
                [2 ]New York Medical College Cardiology Fellowship Program, St. Joseph’s Medical Center, Paterson, NJ, USA.
                Author notes
                Article
                Publisher ID: cmc-10-2016-099
                DOI: 10.4137/CMC.S38172
                PMC ID: 4927107
                PubMed ID: 27398034
                SO-VID: a16967cd-ac74-4ac1-8a90-cac24158aa40
                Copyright © © 2016 the author(s), publisher and licensee Libertas Academica Ltd.
                License:

                This is an open-access article distributed under the terms of the Creative Commons CC-BY-NC 3.0 License.

                History
                Date received : 09 December 2015
                Date revision received : 31 March 2016
                Date accepted : 03 April 2016
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: renal artery stenosis,fibromuscular dysplasia,atherosclerosis
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: renal artery stenosis, fibromuscular dysplasia, atherosclerosis

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