Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. Nov 24, 2018; 7(7): 143-147
Published online Nov 24, 2018. doi: 10.5527/wjn.v7.i7.143
Awakening the sleeping kidney in a dialysis-dependent patient with fibromuscular dysplasia: A case report and review of literature
Mogamat-Yazied Chothia, Mogamat Razeen Davids, Raisa Bhikoo
Mogamat-Yazied Chothia, Renal Unit, Tygerberg Hospital, Cape Town 7505, South Africa
Mogamat-Yazied Chothia, Mogamat Razeen Davids, Raisa Bhikoo, Division of Nephrology, Department of Medicine, Tygerberg Hospital and Stellenbosch University, Cape Town 7505, South Africa
Author contributions: Chothia MY and Davids MR were involved in the care of the patient; all of the authors contributed to writing of the paper and review of the final manuscript.
Informed consent statement: The patient provided consent for publication of this case report and its accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non- commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mogamat-Yazied Chothia, MD, Senior Lecturer, Renal Unit, Tygerberg Hospital, Francie van Zijl Drive, Parow Valley, Cape Town 7505, South Africa. yaziedc@sun.ac.za
Telephone: +27-21-9386590 Fax: +27-21-9385555
Received: August 15, 2018
Peer-review started: August 17, 2018
First decision: August 31, 2018
Revised: September 6, 2018
Accepted: October 10, 2018
Article in press: October 10, 2018
Published online: November 24, 2018
Processing time: 101 Days and 0.1 Hours
Abstract

Renal artery stenosis is a common cause of secondary hypertension and chronic kidney disease. We present here a case of fibromuscular dysplasia that was treated with surgical revascularization, resulting in recovery of kidney function with eventual cessation of chronic dialysis. The case involves a 25-year-old female with coincidentally discovered hypertension, who underwent further investigations revealing a diagnosis of renal artery stenosis due to fibromuscular dysplasia. She subsequently developed two episodes of malignant hypertension, with flash pulmonary oedema and worsening renal failure that resulted in dialysis dependence. After evidence was obtained that the right kidney was still viable, a revascularization procedure was performed, improving blood pressure control and restoring kidney function, thereby allowing dialysis to be stopped. This case highlights the importance of evaluating patients with renal artery stenosis for revascularization before committing them to a life of chronic dialysis.

Keywords: Renal artery stenosis; Fibromuscular dysplasia; Revascularisation; Dialysis; Caes report

Core tip: Renal failure requiring dialysis support is a rare complication of renal artery stenosis due to fibromuscular dysplasia. We present a 25-year-old woman with fibromuscular dysplasia who developed dialysis dependence following acute loss of kidney function after suspected renal arterial dissection. Surgical revascularization resulted in dialysis cessation and improved blood pressure control. This case illustrates that in well-selected dialysis-dependent patients with renal artery stenosis secondary to fibromuscular dysplasia, surgical revascularization may not only improve the control of blood pressure but also restore enough kidney function for dialysis cessation.