Fibromuscular Dysplasia of the Renal Artery-Management and Outcome

Fifty-seven patients (48 women, 9 men) with fibromuscular dysplasia (FMD) of the renal artery were investigated. Mean age at detection of hypertension was 37 years. The diagnosis was established by angiography. Patients with lateralization of renin secretion to the stenotic side had a significantly higher peripheral renin level than those without. The patients were initially treated with surgery (n = 19), percutaneous transluminal renal angioplasty (PTRA) (n = 9), or pharmacologically (n = 29). During a mean follow-up period of 6.2 years, thirteen pharmacologically treated patients were transferred for surgical treatment or PTRA, because of progression of the FMD or inadequate blood pressure control. The long-term effect of surgery (n = 22) on the blood pressure was satisfactory in 91% and that of PTRA (n = 18) in 55%. The low success rate after PTRA seems to be due to an inappropriate selection of patients. Age, duration of hypertension and renal vein renin ratio seem to be important prognostic factors for the outcome of surgery or PTRA.