Nephrotic syndrome and abdominal arterial bruits in a young hypertensive patient: a case report

We report the case of a 34-year-old black African hypertensive woman who presented with nephrotic proteinuria, mild renal failure and abdominal bruits on physical examination. The renal Doppler ultrasound revealed bilateral artery stenosis. Thoracoabdominal aortic nuclear magnetic resonance showed a restriction of proximal descending aorta with post-stenotic spindle dilation while abdominal aorta and iliac vessels appeared diffusely stenotic with atherosclerotic plaques and infrequent spindle dilations and right ostial renal artery stenosis. Renal angiography failed to reveal renal artery stenosis. Right renal biopsy showed type 1 membrano-proliferative glomerulonephritis in sclerotic evolution and severe arteriolosclerosis. The particularly early onset of the disease suggests that the pathogenesis of the membrano-proliferative glomerulonephritis may be multifactorial and related to vascular hypoplasia and chronic renal hypoperfusion leading to renin angiotensin system activation. Hyperlipidemia secondary to nephrotic syndrome may have accelerated systemic atherosclerosis and progression of renal disease.