Coiling in Renovascular Hypertension: A Case Report of Fibromuscular Dysplasia and Complex Urinary Tract Abnormalities
Abstract
Patient: Male, 4-year-old Final Diagnosis: Fibromuscular dysplasia Symptoms: Arterial hypertension • daily urinary incontinence • nocturnal enuresis • urinary tract infection Clinical Procedure: Angioplasty • coil embolization • transurethral incision Specialty: Nephrology • Pediatrics and Neonatology • Radiology Objective: Rare coexistence of disease or pathology Background Arterial hypertension (AH) affects 4% of children, with the most common etiologies including renal parenchymal disease, renovascular abnormalities, and primary hypertension. Severe hypertension in a patient with a urinary tract defect is a rare conjunction, requiring investigation for other coexisting pathologies. Case Report We present the case of a 4-year-old boy with bedwetting, daytime urinary incontinence, and an episode of urinary tract infection, which led to an extensive diagnostic evaluation. The workup revealed bilateral vesicoureteral reflux, posterior urethral valves (PUV), suspected focal lesions in the left kidney, and stenosis of a branch of the right renal artery due to fibromuscular dysplasia. Initially, he required multidrug antihypertensive therapy, and coiling of the narrowed artery resulted in a significant improvement in blood pressure control. The urological conditions required pharmacotherapy for incontinence and an endoscopic transection of PUV. Currently, he remains on ramipril, desmopressin, and mirabegron, with good control of hypertension and urinary incontinence, normal…
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