Secondary Hypertension and Renal Atrophy Unmasking Takayasu Arteritis With Renal Artery Stenosis

Takayasu arteritis is a rare inflammatory arteriopathy predominantly affecting young women and representing an important, often under-recognized, cause of secondary hypertension. Diagnosis is frequently delayed due to nonspecific early manifestations, while advanced vascular lesions may already be established at presentation. A 25-year-old woman with no prior history was referred for incidentally discovered hypertension. Workup excluded common secondary causes but showed elevated inflammatory markers. Imaging revealed severe left renal atrophy with renal artery occlusion, circumferential suprarenal abdominal aortic wall thickening, and superior mesenteric artery ostial stenosis on computed tomography angiography. Takayasu arteritis was diagnosed. Hypertension was attributed to renovascular disease, but revascularization was not indicated due to advanced renal atrophy. The patient was treated with corticosteroids and optimized antihypertensive therapy. This case underscores the insidious presentation of Takayasu arteritis and the pivotal role of imaging in diagnosing active inflammatory lesions. It highlights renovascular hypertension as a key manifestation and emphasizes the importance of assessing renal viability when considering revascularization. In advanced unilateral renal atrophy, the benefit of intervention is limited, and management should prioritize medical therapy. Takayasu arteritis should be considered in young patients with unexplained hypertension and inflammatory syndrome. Early recognition and imaging are essential to guide management and avoid unnecessary interventions in advanced disease.