Renal angioplasty for refractory renovascular hypertension in an adolescent with Takayasu's arteritis: A case report

Takayasu's arteritis (TA) is a rare primary vasculitis, typically affecting the aorta and its main branches causing progressive vessel wall inflammation with concentric wall thickening and stenosis producing a variety of ischemic symptoms or aneurysms. Although etiopathogenesis of this disease remains poorly understood, an autoimmune basis is widely suggested in addition to genetic and environmental factors, among which evidence implicating Mycobacterium tuberculosis (MT) has been provided. We discuss hereby a 12-year-old boy brought with refractory renovascular hypertension secondary to aortoarteritis as found on ultrasound Doppler and computed tomography angiogram, who, apart from fulfilling criteria for TA, was also found to have latent tuberculosis. He was managed with multiple antihypertensives, immunosuppressants, and antitubercular therapy, despite which he developed hypertensive crises. A renal angioplasty proved beneficial as hypertension was better controlled allowing a gradual taper of all antihypertensives over an 8-week period and improved renal blood flow and renal function.