Managing a Patient With Hypertensive Crisis

Renal artery stenosis (RAS) is a common yet under-recognized cause of secondary hypertension and acute kidney injury, especially in elderly patients with multiple comorbidities. We report the case of a 74-year-old woman with longstanding hypertension, chronic kidney disease stage 3, and tobacco use who presented with flash pulmonary edema and hypertensive emergency. Despite a negative renal duplex ultrasound, persistent clinical suspicion prompted further evaluation with renal angiography, which revealed significant right RAS. Following successful stenting, the patient showed marked improvement in renal function and was discharged with stable kidney parameters. This case highlights the importance of integrating clinical judgment, physical exam findings, and laboratory data when noninvasive imaging is inconclusive. It also emphasizes the value of timely intervention in improving patient outcomes and the need to rely on a comprehensive diagnostic approach in high-risk patients.