Bilateral Renal Artery Stenosis Due to Fibromuscular Dysplasia Presenting as Resistant Hypertension in a Young Adult: A Case Report and Literature Review

Background: Fibromuscular dysplasia (FMD) is a rare, non-atherosclerotic, non-inflammatory vascular disease that predominantly affects young individuals, especially women. It is an important but underrecognized cause of secondary hypertension. Case Presentation: We report the case of a 28-year-old man with no prior medical history who presented with severe hypertension discovered incidentally during evaluation for headaches. Despite triple antihypertensive therapy, blood pressure remained poorly controlled. Laboratory tests were unremarkable, and there was no evidence of end-organ damage. Renal Doppler ultrasound and CT angiography revealed bilateral renal artery stenosis consistent with fibromuscular dysplasia. The patient underwent successful percutaneous transluminal balloon angioplasty of both renal arteries without stent placement. Post-procedural follow-up showed significant blood pressure improvement, allowing reduction to monotherapy. Doppler ultrasound controls at 1, 3, 6 months, and annually thereafter confirmed sustained patency without restenosis. Conclusion: This case highlights the importance of considering FMD in young patients with resistant hypertension. Early diagnosis and intervention can result in excellent clinical outcomes without the need for stenting.