Bilateral renal infarction in a black man with medial fibromuscular dysplasia

We report a case of bilateral renal infarction in a patient with medial fib rous dysplasia of both renal arteries and a thrombosed aneurysmal dilatatio n of the right renal artery. A previously healthy 40-year-old black man pre sented to the emergency department with acute onset of bilateral flank pain . Computerized tomography of the abdomen showed bilateral renal infarction, predominantly affecting the anterior distribution of both renal arteries. Estimated loss of renal mass was 50% on the right and 25% on the left. The patient was treated with intravenous heparin, oral warfarin, and antihypert ensive therapy with labetolol and long-acting nifedipine. By day 3, his abd ominal pain resolved; however, the serum creatinine level increased to a ma ximum value of 2.6 mg/dL. The serum creatinine level slowly improved and st abilized at 1.9 mg/dL, and he was subsequently discharged on the seventh ho spital day. Magnetic resonance angiography performed 2 months later showed "beading" of both renal arteries consistent with medial fibromuscular dyspl asia, a finding confirmed by conventional angiography. To our knowledge, bi lateral renal infarction complicating medial fibrous dysplasia of the renal arteries has not been previously reported, nor has medial fibrous dysplasi a been reported in blacks. (C) 2000 by the National Kidney Foundation, Inc.