Review Question - QID 109979

This young woman with edema and hypertension whose renal function declined after starting an ACE inhibitor most likely has fibromuscular dysplasia, which presents with a string-of-beads appearance of the renal arteries on angiography.

Renal artery stenosis is a cause of hypertension that occurs when one or both of the renal arteries are narrowed. The narrowing of these vessels leads to increased production of renin, angiotensin, and aldosterone, which results in increased retention of salt and water. The retained fluid can either stay in the vessels and cause hypertension or third-space to cause lower extremity edema. Importantly, patients with bilateral renal artery stenosis should not be given ACE inhibitors because these drugs may worsen renal function. The most common cause of renal artery stenosis in young women is fibromuscular dysplasia, which presents with a string of beads appearance on angiography.

Incorrect Answers:
Answer 1: Atherosclerotic plaques blocking blood flow in the renal arteries is the most common cause of renal artery stenosis in older men but not in younger women.

Answer 2: Mass present in adrenal cortex would be seen in primary hyperaldosteronism; however, this disease would not present with worsening of renal function after starting on an ACE inhibitor.

Answer 3: Mass present in adrenal medulla would be seen in pheochromocytoma; however, this disease would not lead to volume overload resulting in edema.

Answer 4: No lesions present may be seen in essential hypertension; however, this disease would not present with worsening of renal function after starting on an ACE inhibitor.

Bullet Summary:
Fibromuscular dysplasia is the most common cause of renal artery stenosis in young women and has a string of beads appearance on angiography.