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      Recurrent Pleural Effusion as a Result of Bilateral Renal Artery Stenosis. Does Renal Revascularization Help?

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          Abstract

          Renal artery stenosis (RAS) is the leading cause of secondary hypertension. Renal artery stenosis can result in various cardiopulmonary complications mostly through activation of neurohormonal pathways that result in fluid overload and systemic hypertension. We herein describe a 72-year-old man with recurrent rapidly accumulating transudative pleural effusion in a patient with severe bilateral RAS. Patient pleural effusion resolved following stent placement with revascularization of the left renal artery despite absence of improvement of renal function. Patient renal function continued to decline and ultimately treated with fixed hemodialysis.

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          Cardio-renal syndromes: report from the consensus conference of the Acute Dialysis Quality Initiative

          Claudio Ronco, Peter R. McCullough, Stefan D. Anker … (2009)
          A consensus conference on cardio-renal syndromes (CRS) was held in Venice Italy, in September 2008 under the auspices of the Acute Dialysis Quality Initiative (ADQI). The following topics were matter of discussion after a systematic literature review and the appraisal of the best available evidence: definition/classification system; epidemiology; diagnostic criteria and biomarkers; prevention/protection strategies; management and therapy. The umbrella term CRS was used to identify a disorder of the heart and kidneys whereby acute or chronic dysfunction in one organ may induce acute or chronic dysfunction in the other organ. Different syndromes were identified and classified into five subtypes. Acute CRS (type 1): acute worsening of heart function (AHF–ACS) leading to kidney injury and/or dysfunction. Chronic cardio-renal syndrome (type 2): chronic abnormalities in heart function (CHF-CHD) leading to kidney injury and/or dysfunction. Acute reno-cardiac syndrome (type 3): acute worsening of kidney function (AKI) leading to heart injury and/or dysfunction. Chronic reno-cardiac syndrome (type 4): chronic kidney disease leading to heart injury, disease, and/or dysfunction. Secondary CRS (type 5): systemic conditions leading to simultaneous injury and/or dysfunction of heart and kidney. Consensus statements concerning epidemiology, diagnosis, prevention, and management strategies are discussed in the paper for each of the syndromes.
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            SCAI expert consensus statement for renal artery stenting appropriate use.

            Sahil Parikh, Mehdi H. Shishehbor, Bruce Gray … (2014)
            The pathophysiology of atherosclerotic renal artery stenosis (RAS) includes activation of the renin-angiotensin-aldosterone axis with resultant renovascular hypertension. Renal artery stenting has emerged as the primary revascularization strategy in most patients with hemodynamically significant atherosclerotic RAS. Despite the frequency with which hemodynamically significant RAS is observed and high rates of technical success of renal artery stenting, there remains considerable debate among experts regarding the role of medical therapy versus revascularization for renovascular hypertension. Modern, prospective, multicenter registries continue to demonstrate improvement in systolic and diastolic blood pressure with excellent safety profiles in patients with RAS. Modern randomized, controlled clinical trials of optimal medical therapy versus renal stenting particularly designed to demonstrate preservation in renal function after renal artery stenting have demonstrated limited benefit. However, these trials frequently excluded patients that may benefit from renal artery stenting. This document was developed to guide physicians in the modern practical application of renal stenting, to highlight the current limitations in the peer-reviewed literature, to suggest best-practices in the performance of renal stenting and to identify opportunities to advance the field.
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              Effects of renal artery stent implantation in patients with renovascular hypertension presenting with unstable angina or congestive heart failure.

              Sandeep Khosla, Christopher White, Tyrone J Collins … (1997)
              This study evaluates the effect of renal artery stent implantation in patients with renovascular hypertension presenting with unstable angina (n = 20) or congestive heart failure (n = 28). There was a significant improvement in the Canadian Cardiovascular Society angina class and the New York Heart Association functional class, and at 8.4 +/- 6.4 month follow-up.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Med Insights Case Rep
                Journal ID (iso-abbrev): Clin Med Insights Case Rep
                Journal ID (publisher-id): ICR
                Journal ID (hwp): spicr
                Title: Clinical Medicine Insights. Case Reports
                Publisher: SAGE Publications (Sage UK: London, England )
                ISSN (Electronic): 1179-5476
                Publication date (Electronic): 05 March 2018
                Publication date Collection: 2018
                Volume: 11
                Electronic Location Identifier: 1179547618761378
                Affiliations
                [1-1179547618761378]Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
                Author notes
                [*]Ashraf Abugroun, Department of Internal Medicine, Advocate Illinois Masonic Medical Center, 836 W Wellington Ave, Chicago, IL 60657, USA. Email: ashraf.abugroun@ 123456advocatehealth.com
                Article
                Publisher ID: 10.1177_1179547618761378 Publisher-manuscript ID: ICR-0043789
                DOI: 10.1177/1179547618761378
                PMC ID: 5843098
                SO-VID: 42bac2b3-3dc8-4408-a8cb-50db472f4eed
                Copyright © © The Author(s) 2018
                License:

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                Date received : 20 October 2017
                Date accepted : 5 February 2018
                Categories
                Subject: Case Report
                Custom metadata
                cover-date January-December 2018

                ScienceOpen disciplines: Medicine
                Keywords: renal artery stenosis,hypertension,atherosclerosis,pleural effusion,cardiorenal syndrome,renal artery stent
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: renal artery stenosis, hypertension, atherosclerosis, pleural effusion, cardiorenal syndrome, renal artery stent

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