Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, Zagreb, Croatia.
Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Zagreb, Croatia.
Blood Press. 2021 Dec;30(6):421-427. doi: 10.1080/08037051.2021.2003180. Epub 2021 Nov 18.
We report the case of 39-year-old Caucasian man presenting in emergency department with new onset of severe hypertension with hypokalaemia eight weeks after renal colic. Patient was referred to a hypertension unit for further investigation. Hormonal analysis confirmed secondary aldosteronism and slightly impaired kidney function. Imaging revealed smaller right kidney, 'string of beads appearance' of distal part of right renal artery, a short zone of dissection and renal infarction. Renal scintigraphy showed significant blood flow reduction and severe functional damage of the right kidney. Despite multidrug antihypertensive treatment patient's hypertension was resistant and target organ damage evolved. After initial patient's refusal, he was later successfully treated with laparoscopic simple nephrectomy. Histopathological analysis confirmed renal artery dissection and medial fibroplasia. Thereafter, hypertension was controlled with trandalopril monotherapy. This is a first case report of the patient with renovascular multifocal fibromuscular dysplasia, dissection and renal infarction whose diagnosis of the disease was confirmed by angiography and histopathologic analysis. Resistant hypertension was successfully treated with nephrectomy.
我们报告了一例 39 岁的白人男性病例，他在肾绞痛 8 周后因新发严重高血压伴低钾血症而到急诊就诊。患者被转至高血压专科进一步检查。激素分析证实为继发性醛固酮增多症和轻度肾功能受损。影像学检查显示右肾较小，右肾动脉远端呈“串珠样”外观，夹层短，肾梗死。肾闪烁扫描显示右肾血流量明显减少，功能严重受损。尽管采用了多种降压药物治疗，患者的高血压仍难以控制，靶器官损害不断进展。最初患者拒绝后，后来他成功接受了腹腔镜单纯肾切除术治疗。组织病理学分析证实为肾动脉夹层和中膜纤维增生。此后，他接受曲达普利单药治疗，血压得到控制。这是首例经血管造影和组织病理学分析确诊的多灶性纤维肌性发育不良、夹层和肾梗死伴肾血管性高血压患者的病例报告。经肾切除术成功治疗了难治性高血压。
