Fibromuscular dysplasia, an underdiagnosed etiology of renal artery stenosis
DOI :
https://doi.org/10.5281/hra.v1i1%20Jan-%20Feb-Mar.4697Mots-clés :
fibromuscular dysplasia, renal artery, stenosis LibrevilleRésumé
RÉSUMÉ
Un patient âgé de 16 ans, sans antécédents particuliers, consulte pour des céphalées en casques associées à des troubles visuels. L’examen clinique retrouve une hypertension artérielle grade 3. La biologie met en évidence une insuffisance rénale aigue AKIN 3 avec nécessité d’épuration extra-corporelle. Au plan morphologique, l’échographie doppler des artères rénales avait mis en évidence une asymétrie de la taille des reins associée à une asymétrie des index de résistance. L’angioscanner retrouve une sténose post-ostiale gauche serrée évocatrice d’une dysplasie fibro-musculaire focale. Face à une hypertension artérielle secondaire du sujet jeune, les cliniciens doivent évoquer ce diagnostic devant une asymétrie de la taille des reins et/ou une asymétrie des index de résistance. Une errance diagnostique conduira à une prise en charge non-optimale des chiffres tensionnels, et par conséquent, à une augmentation de la morbi-mortalité liée à l’hypertension artérielle.
Abstract
A 16-year-old patient, with no particular history, is consulted for headaches associated with visual disorders. The clinical examination reveals grade 3 arterial hypertension. Biology reveals AKIN 3 acute renal failure with the need for extracorporeal purification. Morphologically, a Doppler ultrasound of the renal arteries was requested. This revealed an asymmetry of the size of the kidneys associated with an asymmetry of the resistance indexes. The angioCT found a tight left post-ostial stenosis suggestive of a focal fibromuscular dysplasia. When faced with secondary hypertension in young people, clinicians should consider this diagnosis in the presence of asymmetric kidney size and/or asymmetric resistance indexes. Misdiagnosis will lead to suboptimal management of blood pressure, and consequently to an increase in hypertension-related morbidity and mortality.
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