FIBROMUSCULAR DYSPLASIA OF THE RENAL ARTERY (CLINICAL CASE)

Introduction.Renal artery stenosis is one of the leading causes of symptomatic hypertension, especially in young patients.The purpose of the study.Demonstration of clinical case of fibromuscular dysplasia of the renal artery as a cause of symptomatic arterial hypertension.Materials and methods.A clinical case of fibromuscular dysplasia of the renal artery was analyzed at the City Mariinsky Hospital. The disease history, results of clinical, laboratory and instrumental examination methods were studied, and the applied treatment tactics were assessed.Results and discussion.A 20-year-old patient with newly diagnosed severe arterial hypertension was found to have secondary vasorenal hypertension caused by fibromuscular dysplasia with subocclusion of the left renal artery. Initial drug therapy, including beta-blockers and central agonists, was ineffective, which served as a basis for an in-depth diagnostic search for secondary forms of hypertension. According to multispiral computed tomography, stenosis of up to 90% of the left renal artery orifice was detected. Given the intact renal parenchyma and confirmed vasorenal nature of hypertension, endovascular intervention was performed — balloon angioplasty of the affected segment. The operation was uneventful, with positive clinical dynamics: in the postoperative period, persistent normalization of blood pressure was observed without the need for high doses of antihypertensive drugs. The treatment performed confirmed the high efficiency of angioplasty as a method of choice for fibromuscular dysplasia of the renal arteries, especially in young patients with preserved renal function and refractory hypertension. This clinical case emphasizes the need for timely diagnosis of secondary forms of arterial hypertension and an interdisciplinary approach to patient management tactics.Conclusion.The presented clinical case is a typical example of secondary arterial hypertension caused by fibromuscular dysplasia of the renal artery. Despite the patient’s youth and the absence of obvious clinical markers of secondary hypertension at an early stage, the course of the disease was complicated by severe and refractory hypertension, which required careful diagnostics and a comprehensive approach. The endovascular intervention in the form of balloon angioplasty allowed achieving stable normalization of arterial pressure and abandoning combined drug therapy. This confirms the high clinical effectiveness of the minimally invasive treatment method for this pathology. Timely detection and elimination of the cause of vasorenal hypertension helps to improve the prognosis and quality of life of patients, especially at a young age.