The role of integrated radiology in diagnosis and treatment of renal artery stenosis: a case report

Introduction and importance: Renal artery stenosis (RAS) is a significant cause of ischemic nephropathy and secondary hypertension and is often underdiagnosed. While atherosclerosis predominates in older adults, younger patients are affected by various etiologies, such as fibromuscular dysplasia (FMD). Early diagnosis and intervention using integrated radiologic modalities are crucial to prevent irreversible end-organ damage in such patients. Presentation of the case: A 16-year-old male presented with a 6-month history of dizziness and refractory hypertension, with peak readings above 190/100 mm Hg despite aggressive antihypertensive therapy (amlodipine, nifedipine, and spironolactone). His physical examination was unremarkable except for elevated blood pressure (140/100 mmHg). Computed tomography angiography (CTA) of the renal arteries revealed a tight focal stenosis in the right renal artery, with post-stenotic dilation and collateral circulation to both poles of the right kidney. Selective digital subtraction angiography (DSA) confirmed these findings. Percutaneous transluminal renal angioplasty (PTRA) was performed using sequentially larger balloons (2.5 mm to 5.0 mm), and a vascular stent was deployed, achieving complete recanalization and robust distal flow. The patient was discharged on dual antiplatelet therapy with no complaints. Clinical discussion: This case highlights the utility of CTA for detailed anatomical assessment and DSA for confirmation and intervention. The need for stenting post-angioplasty due to residual stenosis underscores the importance of having a comprehensive endovascular strategy. Early and effective management of RAS is crucial to prevent long-term complications in young patients. Conclusion: Integrated imaging is essential for diagnosis, lesion characterization, and procedural planning in RAS patients. Endovascular revascularization is an effective treatment with early technical and clinical success.