Editing Renal Hypertension (section)

== Fibromuscular Dysplasia (FMD) ==

* '''More often seen in younger Caucasian women'''
* '''Usually bilateral''' [think two-clip]
* Most common presenting symptoms: hypertension, headache, and pulsatile tinnitus
* '''Subtypes (4):'''
*# '''Multifocal'''
*## '''Medial fibroplasia'''
*# '''Focal'''
*## '''Perimedial fibroplasia'''
*## '''Intimal fibroplasia'''
*## '''Medial hyperplasia'''

** '''Multifocal'''
*** '''Medial fibroplasia'''
**** '''Most common type of FMD (70-80%)'''
**** Occurs almost exclusively in women between age 25-50
**** '''Lesions involve the distal half of the main renal artery''' and may extend into the branches
**** '''Unlikely to progress to complete occlusion or loss of renal function'''
** Insert figure

** '''Focal'''
*** '''Intimal fibroplasia'''
**** '''Most common type of focal FMD'''§
**** '''May result in dissection, arterial wall hematoma, and renal infarction'''
**** '''Likely to progress to loss of renal function without intervention'''
**** '''See Figure 117-4'''
***** '''Renal arteriogram demonstrates a localized, highly stenotic, smooth lesion involving the distal renal artery, from intimal fibroplasia'''
*** '''Perimedial fibroplasia'''
**** 10-25% of FMD cases
**** Occurs almost exclusively in women but they are younger (age 5-15) than medial fibroplasia
**** '''The stenosis occurs classically in the midrenal artery'''
**** '''Likely to progress to loss of renal function without intervention'''
*** '''Medial hyperplasia'''
**** Rare
**** '''Likely to progress to loss of renal function without intervention'''
* Duplex Doppler ultrasound surveillance of kidney length and cortical thickness should be done once or twice a year.