Muhammad Tayyab, Muhammad Bin Safdar, Imtiaz Ahmad, Khurram Shahzad, Umair Asghar, Adeel Arif.
Frequency of renal artery stenosis in hypertensive patients presenting with flash pulmonary edema.
J Cardiovascular Dis Jan ;16(3):83-93.

BACKGROUND: Flash pulmonary edema is an acute decompensated heart failure and dramatic symptoms of pulmonary edema. It is one of the neglected cause of pulmonary edema. Since the initial observation, many researchers have shown interest in this clinical entity. Non-invasive imaging of renal vessels may be acquired by CT angiography. CT renal angiography is by far statistically correct and thereby, invasive procedure is no longer required. OBJECTIVE: To determine the frequency of bilateral stenosis of renal arteries in hypertensive patients admitted with flash pulmonary edema with preserved LV function. MATERIAL AND METHODS:This was a descriptive observational study carried out at Cardiology Department, Punjab Institute of Cardiology, Lahore over a period of 6 months. 150 patients admitted with flash pulmonary edema were included in this study through non-probability, purposive sampling technique. Patients were scheduled for CT renal angiogram. Thin section 64 multi-slice CT renal angiogram was acquired and the presence or absence of >=70% stenosis in renal arteries was evaluated. RESULTS:The mean age of patients was 35.4+-11.9years. There were 112 (75%) males while 38 (25%) were females. Dyspnea was present in all (100%) patients. According NYHA class, 1 (0.67%) had class II-III, 95 (63.3%) had class III, 12 (8%) fall in class III-IV while 42 (28%) in class IV. Chest pain was present in 15 (10%) cases. Bilateral stenosis of renal arteries was present in 58 (38.7%) subjects. Left renal arterial stenosis was present in 61 (40.7%) cases. Right renal arterial stenosis was detected in 59 (39.3%) subjects. CONCLUSION:The patients admitted with the diagnosis of sudden acute or flash pulmonary edema should be evaluated for the presence of renal artery stenosis especially bilateral stenosis.

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