Kidneys are key in secondary HTN! A case of fibromuscular dy
The present case has been reported in Lancet.

A 29-year-old woman was referred to our renal clinic because of pain in her right flank and severe hypertension; her blood pressure was more than 180/110 mm Hg. She was diagnosed as having treatment-resistant-hypertension because her blood pressure remained high at 157/105 mm Hg despite being treated with three antihypertensive drugs, including a diuretic, at maximum doses.

24-h ambulatory monitoring showed increased daytime and nocturnal (non-dipper pattern) blood pressures. She had no history of previous medical difficulties. She was of normal weight and did not report having headaches or palpitations. On physical examination, she was not found to have oedema or any other relevant clinical findings.

Considering the patient's young age, the absence of a family history or other risk factors for hypertension, and the high level and acute increase in her blood pressure, investigations for secondary causes of hypertension were commenced.

Interestingly, the only abnormal laboratory investigation was a low serum potassium concentration (3·3 mmol/L). However, the ultrasound of the right kidney showed a vascular malformation, raising the possibility of renal artery stenosis. A CT angiogram of the right kidney showed stenosis of the right renal artery, seven variously sized aneurysms-coalescing into a mass of approximately 34 × 27 mm in the right kidney-and an arteriovenous fistula from one of the aneurysms near the right renal artery to the ipsilateral right ovarian vein. The patient was diagnosed with fibromuscular dysplasia (FMD).

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