A 35-year-old woman with a history of middle ear infections presents with a 'string of beads' appearance on renal angiography. She has hypertension. Which underlying vascular disease is responsible?

• A Polyarteritis nodosa affecting the renal artery
• B Fibromuscular dysplasia (FMD) of the renal artery ✓
• C Takayasu arteritis involving the renal artery
• D Atherosclerotic renal artery stenosis

Explanation

Fibromuscular dysplasia (FMD) is a non-inflammatory, non-atherosclerotic arterial disease affecting young to middle-aged women, most commonly involving the renal and internal carotid arteries. The classic angiographic 'string of beads' appearance reflects alternating areas of stenosis and mural aneurysm formation. Medial fibroplasia is the most common histological subtype. Renovascular hypertension results from renal artery stenosis activating the renin-angiotensin system. Polyarteritis nodosa causes segmental necrotizing inflammation. Takayasu arteritis affects large vessels with granulomatous inflammation.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.