Coiling in Renovascular Hypertension: A Case Report of Fibromuscular Dysplasia and Complex Urinary Tract Abnormalities.

BACKGROUND Arterial hypertension (AH) affects 4% of children, with the most common etiologies including renal parenchymal disease, renovascular abnormalities, and primary hypertension. Severe hypertension in a patient with a urinary tract defect is a rare conjunction, requiring investigation for other coexisting pathologies. CASE REPORT We present the case of a 4-year-old boy with bedwetting, daytime urinary incontinence, and an episode of urinary tract infection, which led to an extensive diagnostic evaluation. The workup revealed bilateral vesicoureteral reflux, posterior urethral valves (PUV), suspected focal lesions in the left kidney, and stenosis of a branch of the right renal artery due to fibromuscular dysplasia. Initially, he required multidrug antihypertensive therapy, and coiling of the narrowed artery resulted in a significant improvement in blood pressure control. The urological conditions required pharmacotherapy for incontinence and an endoscopic transection of PUV. Currently, he remains on ramipril, desmopressin, and mirabegron, with good control of hypertension and urinary incontinence, normal renal function, and no recurrent urinary tract infections. CONCLUSIONS We present a unique case of a complex urinary tract defect with associated fibromuscular dysplasia treated with renal artery branch coiling. This combination of conditions is exceptionally uncommon, with only isolated reports in the literature describing such an approach. This case demonstrates the need for multidisciplinary management of children with hypertension and urinary symptoms. What initially appeared to be a straightforward urinary tract infection with bladder dysfunction evolved into a multifaceted clinical scenario requiring a combination of pharmacological management and staged interventional treatment.