Fibromuscular dysplasia of renal arteries presenting with bilateral renal infarction in a young man

Abstract

Fibromuscular dysplasia (FMD) describes a group of conditions which cause nonatheromatous arterial stenoses, most commonly of the renal and carotid arteries, typically in young women. We report the case of a previously healthy 43-year-old white man presenting with acute bilateral flank pain. The pain was more severe on the left side. Initially treated for ureteral colic, he was transferred to the nephrology unit upon recognition of a rising serum creatinine. He was found to have FMD of bilateral renal arteries with resultant infarctions in both kidneys. He was treated with intravenous heparin and, then, warfarin at discharge. At a 16-month review, the patient remained pain-free with normal renal function and with antiplatelet and dual antihypertensive therapy. In conclusion, renal infarction complicating FMD is rare, with most cases involving causative cardiovascular risk factors, including coagulopathy, ischemic heart disease, atrial fibrillation or structural cardiac abnormalities, none of which was present in this case. What makes this case interesting are the clinically significant bilateral renal infarctions due to atypical asymmetric FMD in both kidneys in a young man.

Bilateral Renal Infarctions During the Use of Sumatriptan

“…Renal infarction is a rare diagnosis, resulting from compromised blood flow to the kidney, with the most common causes including thromboembolic etiologies (atrial fibrillation or infective endocarditis), renal artery dissection, or hypercoagulable states. 7 Less common etiologies include fibromuscular dysplasia 8 and vasospasm related to cocaine 9 , 10 or ergotamine 11 use. In an autopsy series of 14,411 bodies, the incidence of renal infarction was 1.4%.…”

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.…”

Renal infarct: a rare disease due to a rare etiology

“…Other reasons such as hypercoagulable states and hematological malignancies can also result in in-situ thrombosis ( 2 ). Non-embolic causes of renal infarct include renal artery stenosis due to fibromuscular dysplasia, dissection, or vasospasm ( 3 ). Drugs like cocaine, tacrolimus, and ergot derivatives that cause vasospasm have also been implicated ( 4 , 5 ).…”