Renovascular Hypertension Secondary to Takayasu Arteritis: Challenges in Diagnosis and Management

Abstract

Renovascular hypertension in children is uncommon, and Takayasu arteritis (TAK) is an especially rare underlying cause. Early diagnosis is challenging because pediatric TAK often lacks classic clinical hallmarks such as pulse deficits, vascular bruits, or elevated inflammatory markers. We are reporting the case of a 14-year-old girl presenting with severe, longstanding hypertension complicated by grade IV hypertensive retinopathy. Despite normal inflammatory markers and symmetrical peripheral pulses, Doppler ultrasound revealed significant left renal artery stenosis, and subsequent computed tomography angiography demonstrated circumferential wall thickening of the infrarenal aorta with near-total occlusion of the left renal artery, consistent with mid-aortic syndrome secondary to TAK. Renal scintigraphy confirmed a poorly functioning left kidney contributing only 5% of total renal function. A multidisciplinary team initiated high-dose corticosteroids, azathioprine, and antiplatelet therapy. Although vascular intervention was recommended, financial constraints prevented revascularization, necessitating reliance on medical treatment and close surveillance. This case highlights the diagnostic complexity of childhood-onset TAK, particularly in resource-limited settings where subtle clinical findings may delay recognition. It emphasizes the value of multimodal vascular imaging in adolescents with severe hypertension. It underscores the importance of coordinated multidisciplinary management and long-term monitoring to preserve organ function and control disease progression.