title: Trapped renal arteries: functional renal artery stenosis due to occlusion of the aorta in the arch and below the kidneys.
abstract: Acute renal failure is a well recognized complication from the use of angiotensin-converting enzyme inhibitors in patients with severe bilateral renovascular disease. A 54-year-old woman presented with acute pulmonary edema with intractable hypertension and a history of lower limb claudication. The addition of lisinopril to her antihypertensive regimen resulted, within 48 h, in the development of acute renal failure that remitted with cessation of the drug. She was found to have a heavily calcified occlusion of her aortic arch and another occlusion of the aorta below the renal arteries. Angiography and Doppler ultrasonography showed normal renal arteries. This is the first reported case of angiotensin-converting enzyme inhibitor-induced renal failure occurring in a patient with atherosclerotic occlusion of the aorta. The literature on suprarenal aortic occlusion is reviewed to determine the manner of presentation, prevalent risk factors and physical findings that typify this unique clinical entity.
authors.affiliation: Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Canada.
authors.forename: D G
authors.initials: DG
authors.lastname: Hackam
authors.forename: L M
authors.initials: LM
authors.lastname: Thain
authors.forename: A
authors.initials: A
authors.lastname: Abassakoor
authors.forename: F N
authors.initials: FN
authors.lastname: McKenzie
authors.forename: J D
authors.initials: JD
authors.lastname: Spence
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000328:Adult; D000368:Aged; D000792:Angiography; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D001024:Aortic Valve Stenosis / Q000150:complications*; D001161:Arteriosclerosis / Q000150:complications; D005260:Female; D006801:Humans; D017706:Lisinopril / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012077:Renal Artery / Q000000981:diagnostic imaging; D012078:Renal Artery Obstruction / Q000175:diagnosis / Q000209:etiology*; D012307:Risk Factors; D018608:Ultrasonography, Doppler
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D017706:Lisinopril