A 32-year-old hypertensive woman has uncontrolled blood pressure on three drugs. Angiography shows bilateral mid-to-distal renal artery stenoses with a classic string of beads appearance. Serum creatinine is normal. What is the most appropriate treatment?

• A Renal artery bypass grafting
• B Lifelong antihypertensive drug therapy alone
• C Nephrectomy of the smaller kidney
• D Percutaneous transluminal balloon angioplasty without stenting ✓

Explanation

The string of beads pattern in a young woman with resistant hypertension is fibromuscular dysplasia of the medial fibroplasia type, affecting the mid and distal renal artery. Balloon angioplasty alone cures or markedly improves hypertension in a majority of these patients, and stenting is not routinely required because recoil and dissection are uncommon, unlike atherosclerotic disease. Open surgery is reserved for complex branch lesions or failed angioplasty.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.