Case history
Case history #1
A 68-year-old man with known coronary artery disease and peripheral vascular disease presents with recurrent episodes of flash pulmonary oedema, worsening kidney function, and progressively difficult-to-control hypertension. An angiogram of the aorta and renal arteries shows a sclerotic aorta with plaque extending into the proximal third of both renal arteries.[Figure caption and citation for the preceding image starts]: Magnetic resonance angiography (3-dimensional volume rendered reconstruction) in a patient with significant bilateral atherosclerotic renal artery stenosis. Arrows indicate proximal bilateral stenosesCourtesy of David J. Sheehan, DO; Radiology Department, University of Massachusetts Medical Center and Medical School [Citation ends].
Case history #2
A 32-year-old woman with no prior medical history is seen for worsening headache and is found to have a BP of 180/110 mmHg. Her BP responds inadequately to thiazide diuretics and calcium-channel blockers. A magnetic resonance angiogram of the renal arteries reveals a beaded appearance indicative of fibromuscular dysplasia.[Figure caption and citation for the preceding image starts]: Magnetic resonance angiography (maximum-intensity projection) in a patient with fibromuscular dysplasia of the renal arteries. Arrow indicates the characteristic irregular contour in the right renal arteryCourtesy of Raul Galvez, MD, MPH and Hale Ersoy, MD; Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School [Citation ends].
Other presentations
RAS due to fibromuscular dysplasia is more common in women <30 years. RAS in general often presents as accelerated, resistant, or malignant hypertension. RAS may be associated with acute decline in kidney function after initiation of renin-angiotensin blockade. It may be diagnosed in assessing an unexplained atrophic kidney, or discrepancy in kidney size >1.5 cm, or sudden, unexplained, and/or recurrent pulmonary oedema.
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