• most commonly affects women age 15-50.
• Noninflammatory and nonatherosclerotic condition caused by abnormal cell development in the arterial wall that can lead to vessel stenosis, aneurysm, or dissection.

Patients to screen

Women age < 50 with 1 of the following:

• Severe or resistant HTN
• Onset of HTN before 35
• Sudden increase in BP from baseline
• increase in creatinine (>0.5-1 mg/dL) ater starting ACE-i/ARB and without significant effect on BP
• Systolic-diastolic epigstric bruit

Clinical presentation

• Resistant HTN from renal artery involvement
• [ ]
  • FMD decreases perfusion to the kidneys, which increases both renin and aldosterone levels (secondary hyperaldosteronism)
  • aldosterone concentration to renin activity ratio is ~10 (<20)
• CNS - brain ischemia (e.g amaurosis fugax, Horner's syndrome, TIA, stroke)
• Non-specific symptoms (headache, pulsatile tinnitus, dizziness) from carotid or vertebral artery involvement
• can also involve iliac, subclavian and visceral arteries

Dx and F-up

• Non-invasive testing preferred (e.g CT angiography, duplex ultrasound)
• Catheter-based digital substraction arteriography if inconclusive
• F-up Medically treated patients with BP and creatinine every 3-4 months & renal ultrasound every 6-12 months