title: Prevalence of renal artery stenosis in flash pulmonary oedema: determination using gadolinium-enhanced MRA.
abstract: 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.
authors.affiliation: Department of Diagnostic Imaging, St. James Hospital, Dublin 8, Ireland. colmjmcmahon@yahoo.co.uk
authors.forename: Colm J
authors.initials: CJ
authors.lastname: McMahon
authors.forename: Martina
authors.initials: M
authors.lastname: Hennessy
authors.forename: Gerard
authors.initials: G
authors.lastname: Boyle
authors.forename: John
authors.initials: J
authors.lastname: Feely
authors.forename: James F M
authors.initials: JF
authors.lastname: Meaney
mesh_terms: 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
chemical_list: D005682:Gadolinium