Bilateral Renal Artery Thrombosis With Distal Abdominal Aortic Dissection as the First Presentation of Takayasu Arteritis.

BACKGROUND: Takayasu arteritis (TAK) is a chronic granulomatous large-vessel vasculitis that predominantly affects the aorta and its major branches, leading to stenosis, occlusion, or aneurysmal changes. Renal artery disease is common, but acute bilateral renal artery thrombosis causing renal dysfunction is rare.

CASE PRESENTATION: A 38-year-old South Asian male presented with a two-week history of abrupt-onset bilateral loin pain and severe azotemia (creatinine 8.25 mg/dL). Inflammatory markers were high (ESR 102 mm/h; CRP 45 mg/L). Ultrasound showed preserved renal size; Doppler suggested globally poor bilateral renal perfusion. CT angiography revealed bilateral renal artery thrombosis, mural thickening of the renal arteries, and a distal abdominal aortic dissection extending to the iliac arteries. Infectious, autoimmune, and limited thrombophilia screens were negative. The clinical and radiological constellation was most consistent with TAK, based on imaging evidence of large-vessel vasculitis involving bilateral renal arteries and compatible clinical findings. A multidisciplinary team (nephrology, vascular surgery, and rheumatology) advised anticoagulation due to bilateral renal artery thrombosis despite the distal Type B dissection. He received intravenous methylprednisolone followed by oral prednisolone, with recovery of renal function to 1.8 mg/dL and normalization of inflammatory markers in a month.

CONCLUSIONS: In young adults presenting with abrupt bilateral renal ischemia and systemic inflammation, TAK should be considered. Early vascular imaging and prompt immunosuppression can preserve renal function. Anticoagulation therapy may be justified in selected cases of thrombosis even in the presence of limited dissection, provided decisions are multidisciplinary and blood pressure is tightly controlled.