Successful hybrid procedure in flash pulmonary edema

Area of Science:

• Cardiology
• Nephrology
• Hypertension

Background:

• Bilateral renal artery disease is a significant cause of uncontrolled hypertension and chronic kidney disease progression.
• Recurrent flash pulmonary edema and acute coronary syndrome can be associated with renal artery stenosis.

Observation:

• A 70-year-old female presented with recurrent flash pulmonary edema and acute coronary syndrome, alongside bilateral renal artery disease and uncontrolled hypertension.
• Initial glomerular filtration rate (GFR) was 45.43 mL/min, with reduced function in the left kidney (12.78 mL/min) and right kidney (32.65 mL/min).
• Angiography revealed significant bilateral atherosclerotic renal artery stenosis and a 90% right coronary artery lesion.

Findings:

• Successful percutaneous transluminal angioplasty of the right renal artery lesion led to improved serum creatinine from 1.6 mg/dL to 1.3 mg/dL, increasing GFR from 45.43 mL/min to 63 mL/min.
• The patient's blood pressure was controlled post-renal artery intervention.
• Subsequently, percutaneous transluminal coronary angioplasty of the right coronary artery lesion was performed.

Implications:

• Renal artery stenosis is a critical factor in managing hypertension and preventing chronic kidney disease.
• Early intervention and revascularization for renal artery stenosis are crucial for preventing end-stage kidney failure.
• Prompt treatment can avert recurrent flash pulmonary edema and improve overall cardiovascular and renal outcomes.