Adventitial Fibromuscular Dysplasia of the Renal Artery

A 19-year-old healthy woman presented with new onset of severe migrainous headache. She did not take medications or use illicit drugs. There was no personal or family history of hypertension. Physical examination revealed a blood pressure of 220/130 mm Hg in both arms. There was no fourth heart sound. She had full and symmetric pulses in the upper and lower extremities with no radial/femoral delay. There were no carotid, subclavian, or abdominal bruits. Fundoscopic examination revealed normal retinal arteries without hypertensive retinopathy. Renal function and serum potassium were normal. Renal artery duplex ultrasonography revealed elevated peak systolic and end-diastolic velocities in the mid to distal portion of the right renal artery, consistent with severe right renal artery stenosis. The left renal artery was normal. The right kidney measured 8.8 cm with atrophy of the right cortical margin. The left kidney was 11.5 cm. There were normal renal resistive indexes …