Renal arterial fibromuscular dysplasia: acute renal infarction in three patients with angiographic evidence of medial fibroplasia

Fibromuscular dysplasia of the renal arteries usually presents with hypertension but, rarely, it can present with acute renal infarction. Of the four types of fibromuscular dysplasia, medial fibroplasia has been said not to progress to renal arterial occlusion (Schreiber et al, 1984) and not to predispose to arterial thrombosis or dissection (Stewart et al, 1970). We report on three patients who presented with acute renal infarction, whose renal angiographic features were more suggestive of the medial fibroplasia type of fibromuscular dysplasia. A 33-year-old man was admitted with severe right loin pain. The right kidney was non-functioning on intravenous urography, but an ultrasound examination of both kidneys was normal. A right retrograde pyelogram was normal, but dynamic renography (99Tcm-DTPA) revealed that the right kidney was not perfused. At angiography the right renal artery was completely occluded by thrombus 3 cm from its origin (Fig. 1). The left main renal artery was irregular and two stenose...