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.

Successful surgical treatment with ex vivo technique in a patient with renal artery aneurysm rupture and bilateral arteriovenous fistula

“…FMD of the renal arteries may be associated with hypertension and, less commonly, with spontaneous dissection, aneurysm, and renal infarcts or hemorrhage. 6 , 7 Association of the FMD with renal aneurysm and AVF is extremely rare and is presented in the literature by a limited series of case reports. In 2002, Torres et al 2 performed successful ex vivo resection of a renal artery aneurysm with AVF in a patient with FMD and hematuria.…”

Unique imaging findings in fibromuscular dysplasia of renal arteries

“…[8–13] It should be noted that bilateral renal infarctions are much less common than unilateral renal infarctions. [8–10,14,15] Acute large renal infarctions usually present with abdominal and flank pain, as well as fever, nausea, vomiting, hypertension, elevated LDH, and leukocytosis. Microscopic hematuria and mild proteinuria may be noted on urinalysis.…”

Acute renal infarction resulting from fibromuscular dysplasia: a case report

“…Sometimes it progresses quickly and may lead to renal infarction because of thrombosis of the poststenotic dilatation of the renal artery. It has been stated that “FMD can easily be differentiated from atherosclerosis, in that it occurs in the middle or distal portions of the artery in younger patients without significant cardiovascular risk, whereas atherosclerosis occurs at the origin or proximal portion of the artery in older patients with cardiovascular risk factors” [ 15 ]. The young age of our patient was typical of FMD, but the stenosis was in a proximal part of a branch of the renal artery, not a distal part.…”