Bilateral Renal Artery Stenosis with Abdominal Aorta Coarctation in a Child with Severe Hypertension

Abstract

This report describes the clinical course, diagnostic evaluation, and management of a 12-year-old child with bilateral renal artery stenosis (RAS) and concurrent narrowing of the abdominal aorta. The child was presented with a 2-day history of headache, vomiting, seizures, and right hemiparesis with normal findings from fundoscopic examination. There were no clinical or laboratory features suggesting the etiology of hypertension, nor had there been any diagnostic procedures in screening for hypertension due to bilateral RAS. Abdominal aortography confirmed the diagnosis of bilateral RAS and abdominal aorta coarctation. The hypertension was severe and resistant to combination of several antihypertensive agents. Aortobilateral renal bypass with autogenous saphenous grafts and midaortic angioplasty with polytetrafluoroethylene (PTFE) was performed. Histopathologic studies revealed subintimal fibrosis.