Adverse outcomes of renovascular hypertension during pregnancy

Background A 26-year-old primigravida, with no history of hypertension, presented at 20 weeks of gestation with severe pre-eclampsia. A pelvic ultrasound revealed intrauterine fetal death, probably caused by placental abruption. The pregnancy was terminated by induction with oxytocin, followed by a vaginal breech delivery. The patient remained hypertensive for 8 weeks after delivery. Investigations Physical examination, laboratory investigation, renal angiogram and renal-vein renin sampling. Diagnosis An atrophic right kidney secondary to an occluded right renal artery, probably caused by dissected fibromuscular dysplasia; a contralateral high-grade stenosis secondary to fibromuscular dysplasia. Management Right nephrectomy and angioplasty of the left renal artery.