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      Flash Pulmonary Edema in a Patient With Unilateral Renal Artery Stenosis and Bilateral Functioning Kidneys

      case-report

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          Abstract

          Flash pulmonary edema typically exhibits sudden onset and resolves rapidly. It generally is associated with bilateral renal artery stenosis or unilateral stenosis in conjunction with a single functional kidney. We describe a patient who presented with flash pulmonary edema treated by percutaneous therapy with stent implantation. Our case is unique in that the flash pulmonary edema occurred in the setting of unilateral renal artery stenosis with bilateral functioning kidneys.

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          The pathogenesis of acute pulmonary edema associated with hypertension.

          Brian Little, D Kitzman, A Nomeir … (2001)
          Patients with acute pulmonary edema often have marked hypertension but, after reduction of the blood pressure, have a normal left ventricular ejection fraction (> or =0.50). However, the pulmonary edema may not have resulted from isolated diastolic dysfunction but, instead, may be due to transient systolic dysfunction, acute mitral regurgitation, or both. We studied 38 patients (14 men and 24 women; mean [+/-SD] age, 67+/-13 years) with acute pulmonary edema and systolic blood pressure greater than 160 mm Hg. We evaluated the ejection fraction and regional function by two-dimensional Doppler echocardiography, both during the acute episode and one to three days after treatment. The mean systolic blood pressure was 200+/-26 mm Hg during the initial echocardiographic examination and was reduced to 139+/-17 mm Hg (P< 0.01) at the time of the follow-up examination. Despite the marked difference in blood pressure, the ejection fraction was similar during the acute episode (0.50+/-0.15) and after treatment (0.50+/-0.13). The left ventricular regional wall-motion index (the mean value for 16 segments) was also the same during the acute episode (1.6+/-0.6) and after treatment (1.6+/-0.6). No patient had severe mitral regurgitation during the acute episode. Eighteen patients had a normal ejection fraction (at least 0.50) after treatment. In 16 of these 18 patients, the ejection fraction was at least 0.50 during the acute episode. In patients with hypertensive pulmonary edema, a normal ejection fraction after treatment suggests that the edema was due to the exacerbation of diastolic dysfunction by hypertension--not to transient systolic dysfunction or mitral regurgitation.
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            Renovascular hypertension and ischemic nephropathy.

            Vesna D. Garovic, S Textor (2005)
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              Catheter-based therapy for atherosclerotic renal artery stenosis.

              Christopher White (2015)
              The prevalence of atherosclerotic renal artery stenosis (RAS) is more common than was previously thought, particularly in patients with known coronary, cerebrovascular, or peripheral vascular atherosclerosis. Clinical subsets in which RAS is more common include patients with uncontrolled hypertension, renal insufficiency, and/or sudden onset ("flash") pulmonary edema. Renal artery atherosclerosis progresses over time and is associated with loss of renal function regardless of medical therapy. Patients with symptomatic (hypertension, renal insufficiency, or flash pulmonary edema) and hemodynamically significant RAS are potential candidates for revascularization. The current standard of care is stent placement for aorto-ostial atherosclerotic lesions. Procedure success rates are very high (> or =95%), with infrequent major complication rates. Five-year primary patency rates are 80% to 85%, and secondary patency rates exceed 90%. The key element in managing patients with RAS is selecting those most likely to benefit, that is, those with blood pressure control, preservation or improvement of renal function, and control of flash pulmonary edema from renal revascularization. This article will highlight the anatomical features, physiologic parameters, and biomarkers that may be helpful in optimally selecting patients for renal artery revascularization.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Korean Circ J
                Journal ID (publisher-id): KCJ
                Title: Korean Circulation Journal
                Publisher: The Korean Society of Cardiology
                ISSN (Print): 1738-5520
                ISSN (Electronic): 1738-5555
                Publication date (Print): January 2010
                Publication date (Electronic): 27 January 2010
                Volume: 40
                Issue: 1
                Pages: 42-45
                Affiliations
                [1 ]Division of Cardiology, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
                [2 ]Division of Radiology, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
                [3 ]Division of Cardiology, Department of Internal Medicine, Hanmaeum General Hospital, Jeju, Korea.
                Author notes
                Correspondence: Dae Kyoung Cho, MD, Division of Cardiology, Department of Internal Medicine, Hanmaeum General Hospital, 52 Yeonsin-ro, Jeju 690-741, Korea. Tel: 82-64-750-9168, Fax: 82-64-750-9600, yumtong001@ 123456naver.com
                Article
                DOI: 10.4070/kcj.2010.40.1.42
                PMC ID: 2812797
                PubMed ID: 20111652
                SO-VID: 815ffa8d-b855-4cea-a77b-1a0afe1aada7
                Copyright © Copyright © 2010 The Korean Society of Cardiology
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 27 April 2009
                Date revision received : 02 July 2009
                Date accepted : 02 September 2009
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: pulmonary edema,renal artery obstruction,stents
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: pulmonary edema, renal artery obstruction, stents

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