Refractory Renovascular Hypertension as the Presenting Manifestation of Takayasu Arteritis: A Case Report

Abstract

Takayasu arteritis is a chronic large- vessel vasculitis that may lead to renovascular hypertension and progressive chronic kidney disease. We report the case of a 32- year- old woman presenting with refractory arterial hypertension, declining renal function, and constitutional symptoms. Physical examination revealed marked inter- arm blood pressure asymmetry and reduced left radial pulse. Laboratory investigations showed severe renal impairment, normocytic anemia, and elevated inflammatory markers.

Computed tomography angiography demonstrated diffuse aortic wall thickening, bilateral renal artery stenosis and occlusion of the left subclavian artery. Positron emission tomography confirmed active vascular inflammation, and renal scintigraphy showed severe hypoperfusion of the right kidney. Treatment was initiated with high- dose corticosteroids and methotrexate and later escalated to tocilizumab due to disease relapse. Right renal artery angioplasty was performed for persistent hypertension and renal deterioration.

During long- term follow- up, the patient achieved sustained clinical remission under biologic therapy, stabilisation of chronic kidney disease, and blood pressure control with intensive antihypertensive treatment, including cautious renin- angiotensin system blockade.

This case highlights the importance of early recognition of Takayasu arteritis in young patients with refractory hypertension and supports an individualised multidisciplinary approach combining immunosuppression, selective revascularisation and optimized cardiovascular risk management.