A 40-year-old man felt giddiness six months before and diagnosed with high blood pressure of 200/110 mmHg. After the investigation, treated but his BP is not under control. His haemoglobin is rising continuously and now it's 18.1gm%. Urea is normal. S-creatinine 2.6 mg, In ultrasonography KUB, kidneys are normal but colour doppler of renal vessels shows bilateral renal artery stenosis, another report after six months states unilateral renal artery stenosis. Urinary VMA is normal.
This patient is a perfect case of renal artery stenosis probably fibromuscular dysplasia (Hypertension uncontrollable fluctuating + renal artery stenosis bilateral +polycythemia). Now, want to send him for renal artery angiography and stenting. But neither BP nor S-creatinine is under control. eGFR is low. Given beta blockers plus CCB . How to diminish S-creatinine and blood pressure?
