WHEN THE DISEASE DOESN’T READ A BOOK - FIBROMUSCULAR DYSPLASIA IN A SEEMINGLY HEALTHY ULTRAMARATHON RUNNER

Objective: The case report presents the patient with a hypertension secondary to fibromuscular dysplasia (FMD). FMD is a rare, idiopathic, non-inflammatory and non-atherosclerotic vascular disease resulting in the stenosis of small and medium-sized arteries. Depending on the stenosis localization, it can cause: renovascular hypertension, stroke, myocardial infarction and other complications. Design and method: The case report presentation of the male patient admitted to the hospital due to the high blood pressure caused by bilateral renal artery stenosis due to FMD. The analysis of symptoms, diagnostic pathway and treatment. Results: A 50-year-old male patient, ultramarathon runner, with the history of triansient ischemic attack and hypertension (treated irregularly with a single pill combination), was admitted to the Department of Internal Medicine and Hypertension due to the high blood pressure (190/110mmHg). He was a non-smoker and denied symptoms such as headaches or dizziness. Laboratory tests revealed slightly elevated NT-pro-BNP (378,8 pg/ml) and creatinine (1,34 mg/dl) level. Electrocardiography showed sinus rhythm, without any features of acute ischaemia. Ambulatory blood pressure monitoring revealed elevated blood pressure (average: 160/110 mmHg) with typical nocturnal decrease. Doppler USG showed asymmetric renal size (with larger left kidney), without renal artery stenosis. The hypotensive treatment was applied. Following the intensification of the angiotensin-converting enzyme inhibitor treatment, the elevation in creatinine and potassium level was observed. The angio-CT was performed and showed stenosis of both renal arteries with typical image for FMD, along with asymmetry in kidney size and enhancement: the right kidney was smaller, showed weaker arterial-phase enhancement, and lacked contrast opacification in the delayed phase. The patient was referred to the Department of Vascular Surgery and underwent a successful renal artery angioplasty. He was subsequently enrolled in the registry for FMD. Conclusions: Fibromuscular dysplasia, although most common in young women, smokers, and individuals with genetic disorders, should be considered in the broader hypertensive population. Employing diverse diagnostic methods can facilitate early detection, enabling timely surgical intervention and reducing the risk of complications.