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A 34-year-old woman with an insignificant past medical history presents with unrelenting headaches for the past 2 weeks. She has a temperature of 36.8°C, blood pressure of 168/102 mmHg, heart rate of 96 beats per minute, respiratory rate of 16 breaths per minute, and oxygen saturation of 98% on room air. One year prior to this episode, her recorded blood pressure was 134/86 mmHg. Physical examination was unremarkable except for a faint bruit on the left side just inferior to the costal margin. Laboratory studies reveal a serum sodium of 148 mEq/L and a serum potassium of 2.8 mEq/L. Magnetic resonance angiography (MRA) shows a “string of beads” appearance of the left renal artery. Which of the following laboratory values do you expect with this condition?

Question

A 34-year-old woman with an insignificant past medical history presents with unrelenting headaches for the past 2 weeks. She has a temperature of 36.8°C, blood pressure of 168/102 mmHg, heart rate of 96 beats per minute, respiratory rate of 16 breaths per minute, and oxygen saturation of 98% on room air. One year prior to this episode, her recorded blood pressure was 134/86 mmHg. Physical examination was unremarkable except for a faint bruit on the left side just inferior to the costal margin. Laboratory studies reveal a serum sodium of 148 mEq/L and a serum potassium of 2.8 mEq/L. Magnetic resonance angiography (MRA) shows a “string of beads” appearance of the left renal artery. Which of the following laboratory values do you expect with this condition?

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Solution

The condition described in the scenario is suggestive of fibromuscular dysplasia, a non-atherosclerotic, non-inflammatory disease of the blood vessels that primarily affects the renal and carotid arteries. The "string of beads" appearance on MRA of the renal artery is a classic finding. This condition can lead to renovascular hypertension, as suggested by the patient's high blood pressure and the bruit heard over the renal artery.

Renovascular hypertension can stimulate the renin-angiotensin-aldosterone system, leading to increased aldosterone secretion. Aldosterone promotes sodium reabsorption and potassium excretion in the distal nephron. Therefore, in this condition, you would expect to see increased levels of plasma renin and aldosterone.

The patient's serum sodium is already high at 148 mEq/L (normal range: 135-145 mEq/L), and her serum potassium is low at 2.8 mEq/L (normal range: 3.5-5.0 mEq/L), which is consistent with the effects of increased aldosterone.

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