Resistant Renovascular Hypertension in Youth: Fibromuscular Dysplasia or Takayasu Arteritis?

Abstract

BACKGROUND Arterial hypertension in pediatric patients often presents complex diagnostic and therapeutic challenges. The diagnosis of hypertension in children is based on different guidelines than in adults, with arterial hypertension in children defined as systolic and/or diastolic blood pressure values at or above the 95th percentile for age, sex, and height. Unlike adult populations, it is predominantly secondary in etiology, with conditions such as renovascular hypertension as common causes. Fibromuscular dysplasia and Takayasu arteritis are frequent underlying causes of renal artery stenosis associated with this patient population. CASE REPORT This case report details the successful management of a 15-year-old girl with severe symptomatic hypertension. Plasma renin and aldosterone concentration analysis, Doppler ultrasonography, and angiography were crucial in assessing the severity and nature of the renal stenosis, leading to a diagnosis of renovascular hypertension associated with fibromuscular dysplasia. The patient underwent 2 successful percutaneous transluminal renal angioplasties, achieving blood pressure control without the need for long-term pharmacological therapy. CONCLUSIONS In children with elevated blood pressure, secondary hypertension should always be considered and investigated. The diagnosis of renal artery stenosis necessitates a multidisciplinary approach, combining laboratory tests and invasive and non-invasive imaging techniques. Ultrasound is often insufficient for comprehensive and detailed imaging of the renal arteries, being susceptible to error. Careful and comprehensive management of similar cases in specialized centers is essential for ensuring optimal patient care.