A 31-year-old woman has newly diagnosed hypertension poorly controlled on three drugs. Renal digital subtraction angiography shows bilateral beaded ('string of beads') narrowing of the mid and distal renal arteries with the proximal segments spared. Her serum creatinine is normal. What is the most appropriate treatment?

• A Percutaneous transluminal balloon angioplasty, usually without stenting ✓
• B Renal artery bypass grafting
• C Nephrectomy of the smaller kidney
• D Medical therapy with an ACE inhibitor alone, no intervention

Explanation

The beaded appearance of the mid and distal renal artery with sparing of the ostium and proximal segment is characteristic of medial fibromuscular dysplasia, the classic cause of secondary hypertension in a young woman. Percutaneous balloon angioplasty alone gives durable cure or marked improvement of hypertension in most patients; stenting is reserved for complications such as dissection. This contrasts with atherosclerotic renal artery stenosis, where angioplasty has shown no advantage over medical therapy.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.