Prevalence of renal artery stenosis in flash pulmonary oedema: determination using gadolinium-enhanced MRA.
OBJECTIVE
The primary purpose was to determine the prevalence of renal artery stenosis (RAS) in patients presenting with acute ("flash") pulmonary oedema (FPE), without identifiable cause using contrast-enhanced magnetic resonance angiography (CE-MRA) of renal arteries. A secondary goal was to correlate clinical parameters at presentation with the presence or absence of RAS.


METHODS
Patients presenting with acute pulmonary oedema without identifiable cause prospectively underwent CE-MRA. >50% renal artery stenosis was considered significant. Clinical parameters (blood pressure, serum creatinine, history of hypertension/hyperlipidaemia) were compared in patients with and without RAS using an unpaired t-test. Results expressed; mean (+/-SD).


RESULTS
20 patients (4 male, 16 female, age 78.5+/-11 years) underwent CE-MRA. 9 patients (45%) had significant RAS (6 (30%) bilateral, 3 (15%) unilateral). Systolic BP was higher in patients with RAS (192+/-38 mm Hg) than those without (134+/-30 mm Hg) (p<.005). Diastolic BP was higher in patients with RAS (102+/-23 mm Hg) than those without (76+/-17 mm Hg) (p<.01). All patients with RAS and 6/11(55%) patients without RAS had a history of hypertension. No significant difference in creatinine or hyperlipidaemia history was observed.


CONCLUSIONS
The prevalence of RAS in patients presenting with FPE is 45%. The diagnosis should be considered in patients presenting with unexplained acute pulmonary oedema, particularly if hypertensive at presentation.
McMahon
Colm J
CJ
Department of Diagnostic Imaging, St. James Hospital, Dublin 8, Ireland. colmjmcmahon@yahoo.co.uk
Hennessy
Martina
M
Boyle
Gerard
G
Feely
John
J
Meaney
James F M
JF
D000208:Acute Disease; D000368:Aged; D001794:Blood Pressure; D005260:Female; D005682:Gadolinium; D006801:Humans; D006977:Hypertension, Renal / Q000453:epidemiology / Q000473:pathology; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000453:epidemiology*; D012077:Renal Artery / Q000473:pathology*; D012078:Renal Artery Obstruction / Q000453:epidemiology* / Q000473:pathology*; D012720:Severity of Illness Index
D005682:Gadolinium