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

Noh, Hye Jin; Jo, Hyun Chul; Yang, Ji Hyun; Kim, Sang Min; Lee, Hyun Jong; Choi, Joon Hyuk; Choi, Seong Hee; Song, Bong Geun; Choe, Yeon Hyeon; Choi, Seung Hyuk; Kim, Duk Kyung; Cho, Dae Kyung

doi:10.4070/kcj.2010.40.1.42

Cited by 9 publications

(6 citation statements)

References 11 publications

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“…Potential pathophysiological mechanisms involved in our patient's presentation are complex and probably do involve the RAS (renin-angiotensin-aldosterone) system. We agree with Noh et al [ 7 ] who have proposed that patients with underlying left ventricular hypertrophy secondary to long standing hypertension have possible diastolic dysfunction and that the left ventricular end diastolic pressures are raised at baseline in this population [ 8 ]. The physiology of these noncompliant left ventricles is compromised by sudden small increase in left ventricular end diastolic volume (possibly from a sudden surge in the RAS system) which leads to significantly raised left ventricular end diastolic pressures and subsequent pulmonary edema.…”

Section: Discussionsupporting

confidence: 91%

Emergent Unilateral Renal Artery Stenting for Treatment of Flash Pulmonary Edema: Fact or Fiction?

Khan

McFadden

2015

Case Reports in Cardiology

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Flash pulmonary edema is characteristically sudden in onset with rapid resolution once appropriate therapy has been instituted (Messerli et al., 2011). Acute increase of left ventricular (LV) end diastolic pressure is the usual cause of sudden decompensated cardiac failure in this patient population. Presence of bilateral renal artery stenosis or unilateral stenosis in combination with a single functional kidney in the susceptible cohort is usually blamed for this condition. We describe a patient who presented with flash pulmonary edema in the setting of normal coronary arteries. Our case is distinct as our patient developed flash pulmonary edema secondary to unilateral renal artery stenosis in the presence of bilateral functioning kidneys. Percutaneous stent implantation in the affected renal artery resulted in rapid resolution of pulmonary edema.

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Section: Discussionsupporting

confidence: 91%

Emergent Unilateral Renal Artery Stenting for Treatment of Flash Pulmonary Edema: Fact or Fiction?

Khan

McFadden

2015

Case Reports in Cardiology

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“…18 -20 Not surprisingly, previous studies show that patients with a solitary kidney and renal artery stenosis, falling into the category of the 1-kidney 1-clip hypertension model, are at high risk of developing flash pulmonary edema. 6,18,20 In our case, the patient denies relevant history and remained free of dyspnea at follow-ups.…”

Section: Clinical Manifestations and Possible Pathophysiologymentioning

confidence: 60%

“…Another important issue for these patients is that they might develop Pickering syndrome, in which patients with renal artery stenosis experience multiple episodes of acute pulmonary edema . First reported by Thomas G. Pickering, this conundrum has been well studied, and its main pathophysiologies are noted: increased hemodynamic burden, activation of RAAS, defective pressure natriuresis, cardiac diastolic dysfunction, and failure of the pulmonary capillary blood‐gas barrier . Not surprisingly, previous studies show that patients with a solitary kidney and renal artery stenosis, falling into the category of the 1‐kidney 1‐clip hypertension model, are at high risk of developing flash pulmonary edema .…”

Section: Discussionmentioning

confidence: 99%

Fibromuscular Dysplasia Affecting a Two‐Branched Renal Artery in a Patient With a Solitary Kidney: Case Presentation

Jiang

Dong

et al. 2013

Clinical Cardiology

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Fibromuscular dysplasia (FMD) is a nonatherosclerotic, noninflammatory arterial disease, commonly involving the renal arteries. Here we report a case of a 16-year-old Chinese male who was found to have severe hypertension with proteinuria for 2 years. Computed tomography showed absence of the left kidney and enlargement of the right kidney. Subsequent angiography confirmed the above findings and revealed narrowing of both the upper and lower branches of the right renal artery caused by FMD. These combined lesions are very rare, and individuals affected are at increased risk of renal dysfunction if left untreated. Treatment with percutaneous balloon angioplasty is the first choice in such a patient and usually results in optimal outcomes.

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“…We included 19 case reports– and six single‐centre case series,,– and retrospective studies. We excluded one patient described by Pun et al .…”

Section: Resultsmentioning

confidence: 99%

The efficacy of renal angioplasty in patients with renal artery stenosis and flash oedema or congestive heart failure: a systematic review

Berg¹,

Deinum²,

Postma³

et al. 2012

European J of Heart Fail

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AimsRecent randomized controlled trials have reported that angioplasty does not have a beneficial effect compared with pharmacological treatment on blood pressure and renal function in patients with atherosclerotic renal artery stenosis (RAS). We aimed to explore systematically the evidence that angioplasty is effective in subgroups of patients with RAS and either flash pulmonary oedema or congestive heart failure (CHF) and renal insufficiency. Methods and resultsWe searched online databases (PubMed and ClinicalTrials.gov) and references of included articles. We included 25 articles describing 79 patients with RAS and flash oedema and seven articles describing 94 patients with RAS, CHF, and renal insufficiency. According to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, the quality of the evidence was, at best, low. Seventy-six per cent of patients with flash oedema did not have any recurrence after angioplasty. Recurrence of symptoms was associated with either restenosis of the renal artery or cardiac arrhythmias in all patients. In the patients with CHF and renal insufficiency, the severity of heart failure symptoms, expressed as New York Heart Association (NYHA) functional class, improved after angioplasty in all included articles. ConclusionThe evidence included in this systematic review justifies a weak recommendation in favour of angioplasty in patients with atherosclerotic RAS and either flash pulmonary oedema or CHF and renal insufficiency.--

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

Cited by 9 publications

References 11 publications

Emergent Unilateral Renal Artery Stenting for Treatment of Flash Pulmonary Edema: Fact or Fiction?

Emergent Unilateral Renal Artery Stenting for Treatment of Flash Pulmonary Edema: Fact or Fiction?

Fibromuscular Dysplasia Affecting a Two‐Branched Renal Artery in a Patient With a Solitary Kidney: Case Presentation

The efficacy of renal angioplasty in patients with renal artery stenosis and flash oedema or congestive heart failure: a systematic review

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