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Nephrology


Answer 1
  1. Perform percutaneous angioplasty of the stenotic lesion. Fibromuscular dysplasia is a disease of predominantly young women. It presents with severe hypertension, often accompanied by hypokalemia and metabolic alkalosis. These metabolic disturbances are due to secondary hyperaldosteronism. The treatment of choice is percutaneous balloon angioplasty, which often is curative. In contrast, atherosclerotic renal artery disease is frequently resistant to balloon angioplasty alone and requires either stent placement or renal artery bypass surgery. ACE inhibitors would control blood pressure; however, the stenotic kidney would develop ischemia and lose function. Serial ultrasonography of the kidney, to document ischemic renal atrophy, would not be appropriate as the patient already qualifies for intervention based on the high-grade lesion. Renal artery bypass would only be indicated if balloon angioplasty failed.

    SUGGESTED READINGS
    1.
     Brewster UC, Setaro JF, Perazella MA. The renin-angiotensin-aldosterone system: cardiorenal effects and implications of renal and cardiovascular disease states. Am J Med Sci 2003;326:15–24.

    2. Cruz DN, Perazella MA. Hypertension and hypokalemia: unusual syndromes. Connecticut Med 1997;61:67–75.

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