Renal Artery Stenosis Due to Fibromuscular Dysplasia in an 18-Week Pregnant Woman

BACKGROUND: Hypertension is a frequent medical complication of pregnancy. Renovascular hypertension is present in 5-10% of cases of severe hypertension during pregnancy. CASE: In this report we describe a 36-year-old woman with severe hypertension caused by bilateral renal artery stenosis due to fibromuscular dysplasia. Guided by the patient's ultrasound findings, only 1 side was treated with angioplasty. Continued labile blood pressure resulted in arteriography of the contralateral renal artery, which confirmed renal artery stenosis was present on the other side. CONCLUSION: Clinicians should maintain a high index of suspicion for renovascular hypertension in pregnancy when drug resistance is present. Because the potential for false-negative results with noninvasive testing for renal artery stenosis is present, if clinical suspicion is high, one should consider using invasive testing.