Madeleine Cosgrave1,2, Limy Wong1,2, Lawrence P McMahon1,2
1Department of Renal Medicine, Eastern Health, , Australia, 2Eastern Health Clinical School, Monash University, , Australia
Biography:
Madeleine is a renal physician, having completed her renal training in 2022. She went on to do an obstetric medicine fellowship and is now completing a PhD in postpartum hypertension.
Background:
Recognition of secondary causes of hypertension is increasing and international guidelines are being updated to consider screening in all young adults with hypertension.
Case report:
A 33-year-old woman was referred to renal clinic with hypertension and an ambulatory 24-hour blood pressure monitor (ABPM) mean blood pressure (BP) 158/112 mmHg with a ‘non-dipper’ pattern. The patient was a non-smoker with no family history of early-onset hypertension. Diagnosed with hypertension five years prior, (systolic BP 170), initial proposed management was weight loss, despite a normal body mass index (BMI). Diet and exercise changes did little. A new GP performed ABPM, and commenced medication.
In clinic, BP was 182/127 and BMI 24. Secondary screening was performed. Creatinine was 55 micromol/L, potassium 4.1 mmol/L and urine albumin:creatinine ratio 10.9 mg/mmol. Plasma metanephrines and aldosterone:renin ratio were normal, however renin was >500mIU/L. Echocardiogram revealed normal left ventricular wall thickness and function. Renal Doppler ultrasound and CT angiogram showed mid-right renal artery stenosis and extensive retroperitoneal arterialised collaterals.
Angiogram confirmed severe stenosis in the mid-artery, with arterial irregularities suggestive of fibromuscular dysplasia (FMD). Balloon angioplasty was performed and six weeks later BP was 136/87 on a single agent. Imaging for cranio-cervical FMD was negative. The patient expressed relief at receiving a diagnosis and appropriate treatment, having previously felt stigmatised, with associated mental health sequelae. She had also delayed family planning.
Conclusion:
While diet and exercise optimisation are essential in hypertension management, secondary screening should be considered for young adults. Early identification and treatment prevent long-term target organ damage and, in women, facilitate safer pregnancy planning.