Bloch MJ, August P, Trost W, Sos TA, Pickering TG
Reversible pulmonary edema due to bilateral renal artery
stenosis
12th Annual ASH Meeting
Am J Hypertens
(Apr) 10:8A 1997
This is an extension of an earlier study which describes pulmonary embolism
(PE) as a
complication
of bilateral renal artery stenosis, or of renal artery stenosis (RAS) in a
solitary
functioning kidney. The purpose of the study was to define the clinical
characteristics
of patients with bilateral renal artery stensosis and PE and their response
to stent
placement.
Out of a cohort of 77 patients with renovascular disease, 16 had a history
of
PE and adequate clinical follow up. 13 of these had bilateral RAS and 3 had
unilateral RAS. All underwent stent placement. At a mean follow up of 17
months-after
stent placement, 11
of the patients with bilateral RAS were free of PE. The remaining two had
recurrent
PE and were found to have bilateral restenosis. Only one of the three with
unilateral RAS was free of PE after stent placement.
Prior to stent placement 82% of the 11 subjects who were cured from PE had
moderate to severe hypertension, 91% had renal insufficiency and 91% had
normal left ventricular function.
Stent placement, in addition to curing PE, resulted in significantly
improved blood pressure levels, and renal function and reduced the number of
medications needed to control the blood pressure.
pre-stent post-stent p-value
BP 187/88 153/80 < 0.05
Scr 3.2 1.7 < 0.01
#BP meds 4.0 2.4 < 0.01
The authors conclusions were, that patients with unexplained PE,
hypertension, renal
insufficiency and normal
left ventricular function should be considered for evaluation for RAS.
Comment: This is a straightforward, informative descriptive study
which brings to
attention a newly recognized potentially treatable complication of
renovascular hypertension.
(Samy S. Iskandar, MBBCh, PhD, Bowman Gray School of Medicine, Winston-
Salem, NC)
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12th Annual ASH Meeting
H: Pathophysiology :
Heart in hypertension
H: Special problems :
Renovascular hypertension