Renal artery stenosis secondary to atherosclerosis accounts for around 90% of renal vascular disease, with fibromuscular dysplasia being the most common cause of the remaining 10% (consider in patients under 50).

• Consider fibromuscular dysplasia in young female patients who develop AKI after the initiation of an ACE inhibitor

Epidemiology

• 90% of patients are female

Features

• hypertension
• chronic kidney disease or more acute renal failure e.g. secondary to ACE-inhibitor initiation
• acute setting: 'flash' pulmonary oedema
• MR angiography confirms the diagnosis with the finding of 'string of beads' appearance of the renal arteries

Management

• lifestyle modifications - for atherosclerotic disease
• Anti-hypertensive therapy
• Statins and anti-platelets
• Consider renal artery stenting