• Fibromuscular dysplasia
• renal artery stenosis
• nephrology
• interventional radiology
• hypertension
• CT
• diagnostic radiology
• MRI

A 45-year-old woman with hypertension (baseline mean 24 h blood pressure 200/120 mm Hg) was referred with a deterioration in renal function, creatinine rising to 207 μmol/l (normal range 64–104 μmol/l) from a baseline of 97 μmol/l. At referral she was taking lisinopril 20 mg once daily, bendroflumathiazide 2.5 mg once daily, lercanidipine hydrochloride 10 mg once daily, and propanolol 40 mg twice daily, with an achieved 24 h mean blood pressure of 133/86 mm Hg.

Clinical examination revealed a thin woman with a loud mid-abdominal bruit, but no other abnormal findings. Lisinopril was stopped, with a subsequent improvement in renal function (creatinine 96 μmol/l).

Renal artery stenosis was suspected. Computed tomography angiography (CTA) (figure 1) showed abnormalities in several branches of the abdominal aorta, including a beaded appearance of both renal …