A 32-year-old woman presents with newly diagnosed severe hypertension and an abdominal bruit. CT angiography shows beading of the right renal artery beyond its middle third, alternating stenoses and dilatations, without atherosclerotic plaque. What is the underlying pathology?

• A Fibromuscular dysplasia of the medial type ✓
• B Takayasu arteritis involving the renal artery ostium
• C Atherosclerotic renal artery stenosis
• D Polyarteritis nodosa of the renal artery

Explanation

Medial fibromuscular dysplasia is the classic cause of renovascular hypertension in young women. It affects the middle and distal segments of the renal artery, producing the angiographic string-of-beads pattern caused by alternating areas of medial thickening and aneurysmal dilatation. Takayasu typically narrows the ostium of the renal artery along with the aorta, and atherosclerosis occurs in older patients with plaque at the origin.

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

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Written and medically reviewed by the StethoPrep medical team.