Abstract
In the present case, extremely high blood pressure was identified in a school-based screening in a 13-year-old girl. Based on the detection of differences in blood pressure between the upper and lower limb, and abdominal bruit, an abnormality of the thoracoabdominal aorta was suspected. Contrast-enhanced computed tomography showed hypoplasia throughout the abdominal aorta, and the left and right renal arteries, as well as atrophy of the right kidney. In addition, stenosis was observed in part of the abdominal aorta distal to the renal artery bifurcation. Catheterization showed a pressure differential of 40 mmHg at this site, and this was thought to be the cause of the difference in blood pressure between the upper and lower limbs. Plasma renin activity was markedly increased after captopril administration. Based on these findings, mid-aortic syndrome and renovascular hypertension were diagnosed. In addition, captopril renography showed marked functional impairment of the right kidney. Oral antihypertensive drugs were initiated but were not effective. Catheter intervention and surgical treatment were considered difficult based on the morphology of the renal vessels, and a nephrectomy of the non-functioning kidney was performed. We also increased the dose of oral medications. With systolic blood pressure at 150−160 mmHg as of the time of writing, extremely high blood pressure improved a little. Careful follow-up is considered necessary in the future. Moreover, patients with secondary hypertension commonly have no subjective symptoms despite marked hypertension, and blood pressure tests are extremely important to enable early intervention.
