PP.24.19

Objective: Fibromuscular dysplasia (FMD) mostly affects young women and more specifically, renal arteries in the distal or segmental segments. Preeclampsia is a hypertensive disorder unique in pregnancy, consistently involving the kidney. The renin-angiotensin system is implicated in the pathogenesis of both preeclampsia and FMD. When these two entities meet, the outcome can be poor. Design and method: We report the case of a 27 years old female with a history of hypertension, recent pregnancy loss (27 weeks) due to preeclampsia and Hellp syndrome, admitted for uncontrolled hypertension (max. 240 mmHg). Results: Upon admission, high blood pressure (BP = 160/110mmHg), normal cardiovascular (including ECG), respiratory and central nervous system examinations were determined, as well as no detectable heart or vascular (including abdominal) bruits. The blood tests revealed elevation of plasmatic renine (286 pg/ml), negative urinary metanephrines, thyroid hormones, prolactine, testosterone, dehydroepiandrosterone, dehydroepiandrosterone-sulfate and 17-OH progesterone, as well as normal creatinine clearance. Ecocardiography showed moderate concentric hypertrophy and normal heart function. The probability of secundary hypertension was outlined. Renal ecography showed a difference between kidneys >1.5 cm (left kidney 12.6 cm > right kidney 9.75 cm). Renal arteriography revealed important stenosis (90%) in the distal segment of the right renal artery. Consequently, balloon angioplasty for the stenotic lesion was applied. Patient's evolution improved dramatically after the procedure (absent headaches and controlled BP). Two weeks after discharge, 24 hours’ Holter monitoring BP showed values below 140/90mmHg without any additional antihypertensive treatment other than beta-blockers and double platelet anti-aggregant. Conclusions: The case was characterized by renovascular hypertension due to fibromuscular dysplasia of renal artery diagnosed in a young female after 27-weeks’ pregnancy loss due to preeclampsia. The report underlines the difficulty of reaching a correct diagnosis and the importance of its’ timing.