Renal vascular disease: The Daily PANCE Blueprint
A 42-year-old female with a history of refractory hypertension presents to your clinic. On physical exam, you appreciate an abdominal bruit. A CT angiography reveals that her renal arteries have areas of stenosis alternating with small aneurysms. Which of the following is the most likely diagnosis?
A. Horseshoe kidney
B. Renal vascular disease due to atherosclerosis
C. Fibromuscular dysplasia
D. Acute renal artery thrombosis
E. Vasculitis
Answer and topic summary
The answer is C. Fibromuscular dysplasia
Renal artery stenosis is characterized by narrowing of the renal arteries. The most common cause overall is atherosclerosis (90%). Other etiologies include fibromuscular dysplasia (10%), usually impacts females under 50 years old), vasculitis, hereditary issues, etc. Most people are asymptomatic; clinical features include hypertension or an abdominal bruit. Screening tests include ultrasound, MR angiography, and CT angiography. Classically, fibromuscular dysplasia will have a “string of beads” appearance due to areas of alternating stenosis with small aneurysms. The gold standard is catheter angiography. Treatment includes ACEI or ARB, statin if indicated and lifestyle modifications; if patients don’t have a good response, revascularization interventions be considered.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Renal System ⇒ ⇒
Also covered as part of the General Surgery EOR and Internal Medicine EOR topic lists
