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.

Main Article Content

Simona Merla
Riccardo Simoni
Stefano Tedeschi
Massimiliano Ferrari
Giovanni Passeri
Carla Marcato
Enrico Epifani
Ignazio Semproni
Giulia Zini
Ignazio Verzicco
Pietro Coghi
Riccardo Volpi
Aderville Cabassi


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


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.


Download data is not yet available.
Abstract 195 | PDF Downloads 100


1) Carey RM, Calhoun DA, Bakris GL, et al.; American Heart Association Professional/Public Education and Publications Committee of the Council on Hypertension; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Genomic and Precision Medicine; Council on Peripheral Vascular Disease; Council on Quality of Care and Outcomes Research; and Stroke Council. Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association. Hypertension. 2018;72(5):e53-e90.
2) Pedicini V, Gennaro N, Muglia R, et al. Renin-dependent hypertension cured with percutaneous radiofrequency ablation. J Hypertens. 2019;37(3):653-656.)
3) Plouin PF, Perdu J, La Batide-Alanore A, Boutouyrie P, Gimenez-Roqueplo AP, Jeunemaitre X. Fibromuscular Dysplasia. Orphanet J Rare Dis 2007; 2:28.
4) Di Monaco S, Lengelé JP, Heenaye S, et al. Prevalence and characteristics of renal artery fibromuscular dysplasia in hypertensive women below 50 years old. Eur J Clin Invest 2019; 49:e13166
5) Pelà G, Bruschi G, Cavatorta A, Manca C, Cabassi A, Borghetti A. Doppler tissue echocardiography: myocardial wall motion velocities in essential hypertension. Eur J Echocardiogr. 2001;2(2):108-17
6) Agabiti-Rosei E, Muiesan ML. Prognostic significance of left ventricular hypertrophy regression. Adv Exp Med Biol. 1997; 432:199-205.
7) Cabassi A, Tedeschi S, Perlini S, et al. Non-steroidal anti-inflammatory drug effects on renal and cardiovascular function: from physiology to clinical practice. Eur J Prev Cardiol. 2019 :2047487319848105. doi: 10.1177/2047487319848105.
8) Gornik HL, Persu A, Adlam D, et al. First International Consensus on the diagnosis and management of fibromuscular dysplasia. Vasc Med 2019; 24(2): 164-189.
9) Kurdi M, Booz GW. New take on the role of angiotensin II in cardiac hypertrophy and fibrosis. Hypertension. 2011;57(6):1034-8.
10) Cabassi A, Bouchard JF, Dumont EC, et al. Effect of antioxidant treatments on nitrate tolerance development in normotensive and hypertensive rats. J Hypertens. 2000;18(2):187-96.
11) Cabassi A, Dancelli S, Pattoneri P, et al. Characterization of myocardial hypertrophy in prehypertensive spontaneously hypertensive rats: interaction between adrenergic and nitrosative pathways. J Hypertens. 2007;25(8):1719-30).
12) Higashi Y, Sasaki S, Nakagawa K, Matsuura H, Oshima T, Chayama K. Endothelial function and oxidative stress in renovascular hypertension. N Engl J Med. 2002;346(25):1954-62).
13) Cabassi A, Binno SM, Tedeschi S, et al. Low serum ferroxidase I activity is associated with mortality in heart failure and related to both peroxynitrite-induced cysteine oxidation and tyrosine nitration of ceruloplasmin. Circ Res. 2014;114(11):1723-32.
14) Zeller T, Rastan A, Schwarzwälder U, et al. Regression of left ventricular hypertrophy following stenting of renal artery stenosis. J Endovasc Ther. 2007;14(2):189-97.
15) Lekston A1, Niklewski T, Gasior M, et al. Effects of short- and long-term efficacy of percutaneous transluminal renal angioplasty with or without intravascular brachytherapy on regression of left ventricular hypertrophy in patients with renovascular hypertension. Pol Arch Med Wewn. 2009;119(4):211-8.
16) Rzeznik D, Przewlocki T, Kablak-Ziembicka A, et al. Effect of renal artery revascularization on left ventricular hypertrophy, diastolic function, blood pressure, and the one-year outcome. J Vasc Surg. 2011;53(3):692-7.
17) Cuspidi C, Dell'Oro R, Sala C, et al. Renal artery stenosis and left ventricular hypertrophy: an updated review and meta-analysis of echocardiographic studies. J Hypertens. 2017;35(12):2339-2345.
18) Symonides B, Chodakowska J, Januszewicz A, et al. Effects of the correction of renal artery stenosis on blood pressure, renal function and left ventricular morphology. Blood Press. 1999;8(3):141-50.
19) Yamori Y, Mori C, Nishio T, et al. Cardiac hypertrophy in early hypertension. Am J Cardiol 1979; 44:964–969.
20) Unger N, Lopez Schmidt I, Pitt C, et al. Comparison of active renin concentration and plasma renin activity for the diagnosis of primary hyperaldosteronism in patients with an adrenal mass. Eur J Endocrinol 2004; 150:517–23.
21) Hartman D, Sagnella GA, Chesters CA, Macgregor GA. Direct renin assay and plasma renin activity assay compared. Clin Chem 2004;50: 2159–61.
22) Herrmann SM, Textor SC. Renovascular Hypertension. Endocrinol Metab Clin North Am. 2019;48 (4):765-778.
23) Chaudhry MA, Latif F. Takayasu's arteritis and its role in causing renal artery stenosis. Am J Med Sci. 2013;346(4):314-8.
24) Kincaid OW, Davis GD, Hallermann FJ, Hunt JC. Fibromuscular dysplasia of the renal arteries. Arteriographic features, classification, and observations on natural history of the disease. Am J Roentgenol Radium Ther Nucl Med. 1968;104(2):271-82
25) Lassiter FD. The string-of-beads sign. Radiology. 1998;206(2):437-8.
26) Hansen KJ, Tribble RW, Reavis SW, et al. Renal duplex sonography: evaluation of clinical utility. J Vasc Surg 1990; 12: 227–236.
27) Williams GJ, Macaskill P, Chan SF, et al. Comparative accuracy of renal duplex sonographic parameters in the diagnosis of renal artery stenosis: paired and unpaired analysis. Am J Roentgenol 2007; 188: 798–811.
28) Vasbinder GB, Nelemans PJ, Kessels AG, Kroon AA, de Leeuw PW, van Engelshoven JM. Diagnostic tests for renal artery stenosis in patients suspected of having renovascular hypertension: a meta –analysis, Ann Intern Med 2001; 135(6) 401-411.
29) Rountas C, Vlychou M, Vassiou K, et al. Imaging Modalities for Renal Artery Stenosis in Suspected Renovascular Hypertension: Prospective Intraindividual Comparison of Color Doppler US, CT Angiography, GD-Enhanced MR Angiography, and Digital Substraction Angiography- Ren Fail 2007; 29(3): 295-302.
30) Trinquart L, Mounier-Vehier C, Sapoval M, Gagnon N, Plouin PF. Efficacy of revascularization for renal artery stenosis caused by fibromuscular dysplasia: a systematic review and metaanalysis. Hypertension 2010; 56: 525-32.

Most read articles by the same author(s)