Research Article
Balloon angioplasty of renal artery stenosis due to Takayasu arteritis in a 2-year-old child

https://doi.org/10.1016/j.jash.2018.04.003Get rights and content

Highlights

  • •

    We successfully performed percutaneous transluminal renal angioplasty for the first time in a patient aged 2 years 2 months who had Takayasu arteritis and renal artery stenosis.

  • •

    There is a coexistence of Takayasu arteritis and hyponatremic-hypertensive syndrome (HHS) in our case. HHS is not rare but is underrecognized.

  • •

    The mechanism of pathogenesis of HHS can be summarized as the activation of RAAS by the unilateral ischemic kidney, which affects the contralateral normal kidney that excretes water and sodium.

Abstract

The aim of this report is to demonstrate a 2-year-2-month-old child who presented with a history of malignant hypertension. He was made the diagnosis of Takayasu arteritis by laboratory tests and angiography; we initiated a treatment with sequential balloon predilation. The patient's blood pressure improved dramatically, and patency of renal artery was demonstrated with renal arteriography over 8 months after the balloon predilation.

Introduction

Takayasu arteritis (TA) is a rare, chronic, and intractable disease of unidentifiable cause involving inflammation of the aorta and its major branches, pulmonary and coronary arteries. It results in dilatation, occlusion, stenosis, and/or aneurysm formation of the affected arteries. These characteristic symptoms of TA patients vary greatly, depending on the affected arteries and the degree of disease progression. These symptoms closely resemble with many diseases causing definitive diagnosis difficult and time consuming. The major peak was significantly higher in the 15- to 29-year age group.1 The prevalence of TA in the general population is not known precisely, but in children, it is a significant cause of renovascular hypertension. Evaluation and early diagnosis of TA will improve morbidity and mortality. Angiography is commonly used for the diagnosis of TA2; we present a case of treatable child hypertension in a 2-year-2-month-old child, who was diagnosed with renovascular hypertension due to TA of the renal artery. He underwent percutaneous transluminal angioplasty; thereafter, his blood pressure became normal without any antihypertensive drug treatment.

Section snippets

Case Report

A 2-year and 2-month old boy was admitted to the pediatric intensive care unit (PICU) with a 2-month history of intermittent vomiting over the preceding, polydipsia over the 2 weeks. He denied a history of photophobia, fever, joint pain, skin rashes on the face, neck, and upper body. He was the second child of nonconsanguineous parents, born by normal vaginal delivery at 37 weeks gestation with a birth weight of 3.95 kg (50th percentile). There was no obvious past history and no family history

Discussion

TA is also known as aortoarteritis. The first case of aortoarteritis was documented in 1830.2 In 1908, Prof. Mikito Takayasu reported a case of typical retinopathy complicated by specific arteriovenous anastomosis. Thereafter, in honor of the scholar, the disease was named after him.3 TA is most commonly found in Japan, Southeast Asia, India, and Mexico.4 The nonspecific clinical manifestations of TA are headache, fever, dyspnea, night sweats, mild anemia, emaciation, joint and muscle pains,

References (11)

  • F. Numano et al.

    Takayasu’s arteritis

    Lancet

    (2000)
  • F. Numano et al.

    Takayasu arteritis-five doctors in the history of Takayasu arteritis

    Int J Cardiol

    (1996)
  • Y. Watanabe et al.

    Current clinical features of new patients with Takayasu arteritis observed from cross-country research in Japan: age and sex specificity

    Circulation

    (2015)
  • S.L. Johnston et al.

    Takayasu arteritis: a review

    J Clin Pathol

    (2002)
  • S. Ozen et al.

    EULAR/PRINTO/PRES criteria for Henoch-Schonlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: ankara 2008. Part II: final classification criteria

    Ann Rheum Dis

    (2010)
There are more references available in the full text version of this article.

Cited by (1)

The authors declare that there are no conflicts of interest related to this study.

View full text
© 2018 American Heart Association. All rights reserved.