{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T12:01:08Z","timestamp":1778068868389,"version":"3.51.4"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"3-4","license":[{"start":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T00:00:00Z","timestamp":1748995200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Fibromuscular dysplasia (FMD) is a vascular disease characterized by abnormal cellular growth in medium-sized arteries progressing to stenosis, aneurysm, or arterial dissection. Renal and carotid artery involvement is common. FMD is not characterized by inflammation or atherosclerosis and predominantly impacts young women. Refractory hypertension is a common primary clinical manifestation of renal artery FMD. Severe or untreated FMD can lead to stroke, aneurysm rupture, or death. Despite the need for early diagnosis and aggressive management, FMD is frequently overlooked because of nonspecific presenting symptoms and perceived rarity. Diagnosis is made by imaging, often ultrasound or computed tomography (CT), though catheter-based angiography remains the gold standard. Because of the systemic nature of FMD, all patients require brain-to-pelvis cross-sectional imaging to screen for aneurysms and dissections. Treatment involves multidrug pharmacologic control of blood pressure; percutaneous transluminal angioplasty is reserved for refractory cases. Here, we present a 43-year-old female soldier with almost 2 decades of elevated blood pressure preceding her diagnosis. Failed treatment with multiple antihypertensive medications prompted further evaluation. Doppler ultrasound and CT angiography revealed bilateral renal artery stenosis with a characteristic \u201cbeaded\u201d appearance, consistent with multifocal FMD. Management included a multidrug regimen of spironolactone, chlorthalidone, telmisartan, and amlodipine, resulting in blood pressure improvement without full resolution of hypertension. Our case highlights the importance of considering FMD in young, hypertensive patients to prevent delayed diagnosis of this potentially debilitating disease.<\/jats:p>","DOI":"10.1093\/milmed\/usaf270","type":"journal-article","created":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T07:36:42Z","timestamp":1748417802000},"page":"e868-e872","source":"Crossref","is-referenced-by-count":0,"title":["A Case of Bilateral Renal Artery Fibromuscular Dysplasia in a U.S. Soldier"],"prefix":"10.1093","volume":"191","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2472-5783","authenticated-orcid":false,"given":"Brianna","family":"Delamare","sequence":"first","affiliation":[{"name":"Internal Medicine Residency, Department of Medicine, Tripler Army Medical Center , Honolulu, HI 96859,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Troy","family":"DeNunzio","sequence":"additional","affiliation":[{"name":"Nephrology Division, Department of Medicine, Tripler Army Medical Center , Honolulu, HI 96859,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,6,4]]},"reference":[{"key":"2026031018442597600_usaf270-B1","volume-title":"StatPearls","author":"Baradhi","year":"2025"},{"key":"2026031018442597600_usaf270-B2","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1161\/01.cir.0000442577.96802.8c","article-title":"Fibromuscular dysplasia: state of the science and critical unanswered questions: a scientific statement from the American Heart Association","volume":"129","author":"Olin","year":"2014","journal-title":"Circulation"},{"key":"2026031018442597600_usaf270-B3","first-page":"e13","article-title":"ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology\/American Heart Association Task Force on clinical practice guidelines","volume":"71","author":"Whelton","year":"2018","journal-title":"Hypertension"},{"key":"2026031018442597600_usaf270-B4","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1148\/radiology.214.3.r00mr18755","article-title":"Arteriographic detection of renovascular disease in potential renal donors: incidence and effect on donor surgery","volume":"214","author":"Neymark","year":"2000","journal-title":"Radiology"},{"key":"2026031018442597600_usaf270-B5","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1148\/radiology.172.1.2662248","article-title":"Incidental fibromuscular dysplasia in potential renal donors: long-term clinical follow-up","volume":"172","author":"Cragg","year":"1989","journal-title":"Radiology"},{"key":"2026031018442597600_usaf270-B6","doi-asserted-by":"crossref","first-page":"3182","DOI":"10.1161\/CIRCULATIONAHA.112.091223","article-title":"The United States registry for fibromuscular dysplasia: results in the first 447 patients","volume":"125","author":"Olin","year":"2012","journal-title":"Circulation"},{"key":"2026031018442597600_usaf270-B7","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1177\/1358863X18821816","article-title":"First International Consensus on the diagnosis and management of fibromuscular dysplasia","volume":"24","author":"Gornik","year":"2019","journal-title":"Vasc Med"},{"key":"2026031018442597600_usaf270-B8","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1161\/HYPERTENSIONAHA.111.00838","article-title":"Association of smoking with phenotype at diagnosis and vascular interventions in patients with renal artery fibromuscular dysplasia","volume":"61","author":"Savard","year":"2013","journal-title":"Hypertension"},{"key":"2026031018442597600_usaf270-B9","doi-asserted-by":"crossref","first-page":"1750","DOI":"10.1016\/j.jacc.2016.01.058","article-title":"Smoking and adverse outcomes in fibromuscular dysplasia: U.S. registry report","volume":"67","author":"O'Connor","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"2026031018442597600_usaf270-B10","doi-asserted-by":"crossref","first-page":"3062","DOI":"10.1161\/CIRCULATIONAHA.112.117499","article-title":"Association between 2 angiographic subtypes of renal artery fibromuscular dysplasia and clinical characteristics","volume":"126","author":"Savard","year":"2012","journal-title":"Circulation"},{"key":"2026031018442597600_usaf270-B11","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1161\/HYPERTENSIONAHA.117.09539","article-title":"High prevalence of multiple arterial bed lesions in patients with fibromuscular dysplasia: the ARCADIA registry (assessment of renal and cervical artery dysplasia)","volume":"70","author":"Plouin","year":"2017","journal-title":"Hypertension"},{"key":"2026031018442597600_usaf270-B12","first-page":"287","article-title":"Segmental arterial mediolysis: a precursor to fibromuscular dysplasia?","volume":"8","author":"Slavin","year":"1995","journal-title":"Mod Pathol"},{"key":"2026031018442597600_usaf270-B13","doi-asserted-by":"crossref","first-page":"2125","DOI":"10.1161\/CIRCULATIONAHA.112.000064","article-title":"Cardiovascular disease in Williams syndrome","volume":"127","author":"Collins","year":"2013","journal-title":"Circulation"},{"key":"2026031018442597600_usaf270-B14","doi-asserted-by":"crossref","first-page":"17004","DOI":"10.1038\/nrdp.2017.4","article-title":"Neurofibromatosis type 1","volume":"3","author":"Gutmann","year":"2017","journal-title":"Nat Rev Dis Primers"},{"key":"2026031018442597600_usaf270-B15","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1161\/HYPERTENSIONAHA.119.14378","article-title":"Brain-to-pelvis imaging substantially impacts management of patients with fibromuscular 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Renal-artery stenosis","volume":"361","author":"Dworkin","year":"2009","journal-title":"N Engl J Med"},{"key":"2026031018442597600_usaf270-B17","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1161\/HYPERTENSIONAHA.110.152918","article-title":"Efficacy of revascularization for renal artery stenosis caused by fibromuscular dysplasia: a systematic review and meta-analysis","volume":"56","author":"Trinquart","year":"2010","journal-title":"Hypertension"},{"key":"2026031018442597600_usaf270-B18","doi-asserted-by":"crossref","first-page":"3825","DOI":"10.1093\/eurheartj\/ehab307","article-title":"Physical activity and exercise in patients with spontaneous coronary artery dissection and fibromuscular dysplasia","volume":"42","author":"Tweet","year":"2021","journal-title":"Eur Heart J"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/191\/3-4\/e868\/63464307\/usaf270.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/191\/3-4\/e868\/63464307\/usaf270.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T22:44:38Z","timestamp":1773182678000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/191\/3-4\/e868\/8159916"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,4]]},"references-count":18,"journal-issue":{"issue":"3-4","published-online":{"date-parts":[[2025,6,4]]},"published-print":{"date-parts":[[2026,3,1]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usaf270","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,3]]},"published":{"date-parts":[[2025,6,4]]}}}