A 26-year-old woman is found to have a blood pressure of 160/90 mm Hg. Similar values are obtained on two subsequent visits. She denies episodic headaches, palpitations, and diaphoresis. She is not obese. On abdominal exam, she is found to have a renal bruit. No abdominal masses are palpated. Her serum creatinine is 1.5 mg/dL. Required:
What is the most likely diagnosis?

Fibromuscular dysplasia

Explanation:

Fibromuscular dysplasia should be suspected in women younger than 35 years with unexplained hypertension. FMD is most commonly seen in women. The renal arteries and extracranial cerebrovascular arteries are most commonly affected and most patients have involvement of multiple arteries. FMD is a noninflammatory, nonatherosclerotic disease that results in arterial occlusion, stenosis, and dissection.