High renin hypertension in focal renal fibromuscular dysplasia: turn off of renin system angiotensin overactivation by renal angioplasty cured high blood pressure and quickly reversed myocardial hypertrophy.

High renin hypertension in focal renal fibromuscular dysplasia: turn off of renin system angiotensin overactivation by renal angioplasty cured high blood pressure and quickly reversed myocardial hypertrophy.

Authors

  • Simona Merla Centro per lo Studio dell’Ipertensione Arteriosa e delle malattie Cardiorenali, Dipartimento di Medicina e Chirurgia, Università di Parma
  • Riccardo Simoni Università di Parma
  • Stefano Tedeschi Università di Parma
  • Massimiliano Ferrari Università di Parma
  • Giovanni Passeri Università di Parma
  • Carla Marcato Azienda Ospedaliera-Universitaria di Parma
  • Enrico Epifani Azienda Ospedaliera-Universitaria di Parma
  • Ignazio Semproni Università di Parma
  • Giulia Zini Università di Parma
  • Ignazio Verzicco Università di Parma
  • Pietro Coghi Università di Parma
  • Riccardo Volpi Università di Parma
  • Aderville Cabassi University of Parma

Keywords:

renovascular hypertension, fibromuscular dysplasia, renin-angiotensin-aldosterone system, myocardial hypertrophy, albumim urine excretion

Abstract

Background Fibromuscolar dysplasia (FMD) is an idiopathic, non-atherosclerotic and non-inflammatory stenotic lesion of renal arteries causing renovascular hypertension up-regulating renin-angiotensin-aldosterone system. Case report: A 18-year-old man was referred to our Hypertension Center (Clinica e Terapia Medica) for the recent onset of hypertension, poorly controlled on calcium channel blockers, already associated to electrocardiographic and echocardiography signs of left ventricular hypertrophy and significant albuminuria (728 mg/24 h). An increased plasma renin activity (PRA), aldosterone level and a mild hypokalemia raised the suspicion of renovascular hypertension. Abdominal CT and MRI angiography showed mild kidneys asymmetry and a tubular stenosis of the right renal artery in its mid-distal portion close to renal hilum. Radionuclide renal scintigraphy documented a kidneys asymmetry of separated glomerular filtration rate. Renal FMD was diagnosed based on patient age and the absence of cardiovascular risk factors for atherosclerosis. Patient successfully underwent right renal angioplasty giving a rapid normalization of blood pressure levels without antihypertensive drugs. Plasma aldosterone and PRA rapidly normalized as well as serum potassium levels. Six months after angioplasty echocardiography showed a regression of left ventricular hypertrophy and the patient albumin urine excretion became normal (14 mg/24 h). Conclusions FMD can cause renovascular hypertension associated to organ damage such myocardial hypertrophy and albuminuria through mechanisms dependent but also independent from blood pressure levels. Renal angioplasty turned off renin-angiotensin-aldosterone overactivity allowing the cure the hypertension and a surprisingly rapid reverse of myocardial hypertrophy and of excess of albumin urine excretion not only dependent on blood pressure normalization.

Author Biographies

Simona Merla, Centro per lo Studio dell’Ipertensione Arteriosa e delle malattie Cardiorenali, Dipartimento di Medicina e Chirurgia, Università di Parma

Clinica e Terapia Medica, Centro per lo Studio dell’Ipertensione Arteriosa e delle malattie Cardiorenali, Dipartimento di Medicina e Chirurgia.

Riccardo Simoni, Università di Parma

Clinica e Terapia Medica, Centro per lo Studio dell’Ipertensione Arteriosa e delle malattie Cardiorenali, Dipartimento di Medicina e Chirurgia

Stefano Tedeschi, Università di Parma

Clinica e Terapia Medica, Centro per lo Studio dell’Ipertensione Arteriosa e delle malattie Cardiorenali, Dipartimento di Medicina e Chirurgia

Massimiliano Ferrari, Università di Parma

Clinica e Terapia Medica, Centro per lo Studio dell’Ipertensione Arteriosa e delle malattie Cardiorenali, Dipartimento di Medicina e Chirurgia

Giovanni Passeri, Università di Parma

Clinica e Terapia Medica, Dipartimento di Medicina e Chirurgia,

Carla Marcato, Azienda Ospedaliera-Universitaria di Parma

Unità di Radiologia Interventistica, Parma, Italy.

Enrico Epifani, Azienda Ospedaliera-Universitaria di Parma

Unità di Radiologia Interventistica, Azienda Ospedaliera-Universitaria di Parma. Parma, Italy.

Ignazio Semproni, Università di Parma

Clinica e Terapia Medica, Dipartimento di Medicina e Chirurgia

Giulia Zini , Università di Parma

Clinica e Terapia Medica, Centro per lo Studio dell’Ipertensione Arteriosa e delle malattie Cardiorenali, Dipartimento di Medicina e Chirurgia

Ignazio Verzicco, Università di Parma

Clinica e Terapia Medica, Centro per lo Studio dell’Ipertensione Arteriosa e delle malattie Cardiorenali, Dipartimento di Medicina e Chirurgia

Pietro Coghi, Università di Parma

Clinica e Terapia Medica, Centro per lo Studio dell’Ipertensione Arteriosa e delle malattie Cardiorenali, Dipartimento di Medicina e Chirurgia

Riccardo Volpi, Università di Parma

Clinica e Terapia Medica, Centro per lo Studio dell’Ipertensione Arteriosa e delle malattie Cardiorenali, Dipartimento di Medicina e Chirurgia

Aderville Cabassi, University of Parma

Clinica e Terapia Medica, Centro per lo Studio dell’Ipertensione Arteriosa e delle malattie Cardiorenali, Dipartimento di Medicina e Chirurgia

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Published

30-04-2021

How to Cite

1.
Merla S, Simoni R, Tedeschi S, Ferrari M, Passeri G, Marcato C, et al. High renin hypertension in focal renal fibromuscular dysplasia: turn off of renin system angiotensin overactivation by renal angioplasty cured high blood pressure and quickly reversed myocardial hypertrophy. Acta Biomed [Internet]. 2021 Apr. 30 [cited 2024 Jul. 18];92(S1):e2021162. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/9358