Clinical characteristics of fibromuscular dysplasia (FMD) in children and adolescents remain poorly characterized compared with those in adults. A systematic review and meta-analysis presented at ESH Congress 2026 evaluated the characteristics of pediatric FMD and compared these findings with those from major adult FMD registries. 

The analysis included studies published since 2000 reportingclinical characteristics of children and adolescents with FMD. Pooled estimates were compared with data from the U.S. Registry for Fibromuscular Dysplasia and the French and Italian Registry of Fibromuscular Dysplasia (FEIRI).

Nine retrospective studies involving 218 children and adolescents with FMD were included. All patients had renal FMD, and 93.7% underwent revascularization. The mean age at diagnosis was 11.7 years.

Findings

• Females accounted for 52.0% of pediatric FMD cases, compared with 94.7% in the U.S. Registry and 81.5% in the FEIRI registry.
• Focal FMD was identified in 66.6% of children, compared with 24.0% and 28.0% of adult patients in the U.S. and FEIRI registries, respectively.
• Multivessel FMD was present in 19.1% of pediatric patients, while aneurysms and dissections were reported in 15.3% and 1.7%, respectively.
• Associated mid-aortic syndrome was identified in 6.3% of children with FMD. Ethnicity-stratified analyses showed lower female prevalence and lower multifocal FMD prevalence among Asian versus Caucasian children. 

The findings suggest that pediatric FMD differs substantially from adult disease, with lower female predominance and a higher proportion of focal lesions. Multivessel involvement and aneurysms were also identified at clinically relevant frequencies despite incomplete vascular screening.