Abstract: TH-PO241
Preeclampsia Superimposed on Secondary Hypertension in the Setting of Fibromuscular Dysplasia
Session Information
- Hypertension and CVD: Clinical - I
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Valdesuso, Alejandro, Landmark Medical Center, Woonsocket, Rhode Island, United States
- Kerns, Eric Scott, Rhode Island Hospital, Providence, Rhode Island, United States
Introduction
Fibromuscular dysplasia (FMD) is a noninflammatory, nonatherosclerotic disorder of medium-sized vessels that leads to arterial stenosis. Most affected vessels are the renal and internal carotid arteries. When to pursue endovascular treatment is not always clear.
Case Description
The patient is an 18-year-old female who had recently given birth presented to the nephrology clinic for evaluation of uncontrolled hypertension possibly related to fibromuscular dysplasia. The patient was first seen to have hypertension at an emergency department when she was 10 weeks 4 days pregnant. At that time, her blood pressure was 176/82 mmHg. She was discharged home on labetalol 100 mg three times a day and referred for obstetric evaluation. At the obstetric clinic, work-up for secondary causes of hypertension was initiated. Renal ultrasound only showed involvement of the right renal artery with 60% stenosis. At 32 weeks 3 days, protein was detected for the first time in the urine and protein-creatinine ratio was 19.4, which represents at least 5000 mg of protein/day. As her blood pressure continued to be difficult to control, nifedipine was added to labetalol. At 32 weeks 5 days, labor had to be induced due to preeclampsia with severe features that included systolic blood pressures raging from 180-200 mmHg and fetal growth restriction. Creatinine remained within normal range throughout the entire pregnancy and afterwards. After leaving the hospital post-delivery, CT angiogram of abdomen/pelvis with and without contrast demonstrated left renal artery stenosis possibly related to FMD. At that time, protein-creatinine ratio had dropped to 0.22. Since then, losartan was added to the previous 2 antihypertensive and her blood pressure is still not well controlled.
Discussion
This patient had hypertension before 20 weeks gestation and proteinuria was first detected at 32 weeks 3 days, making this case one of chronic hypertension that progressed to preeclampsia with severe features. This patient meets criteria for angioplasty since she appears to have bilateral FMD and her blood pressure is not well controlled on as many as 3 antihypertensives. Cure rate of endovascular treatment appears to fall markedly with age. Curing hypertension in her case is preferable in view of her history of preeclampsia with severe features and the patient’s desire to become pregnant again.