International Medical Journal, Vol. 22., Iss. 1, 2016, P. 56−60.
RECURRENT PULMONARY EDEMA IN PATIENTS WITH RENAL ARTERY STENOSIS (PICKERING SYNDROME)
Ulianovsk State University, Russian Federation
Renovascular hypertension due to atherosclerotic renal artery stenosis (ARAS) is one of the most common forms of secondary hypertension. Every five patients with renovascular hypertension have bilateral renal artery stenosis. Development of pulmonary edema in patients with bilateral renal artery stenosis is the most dangerous complication. The aim of this study was to review the literature which discusses the pathogenesis, diagnosis and treatment of patients with ARAS and Pickering syndrome over the recent 20 years. T. G. Pickering et al. (1988) described development of pulmonary edema in patients with bilateral renal artery stenosis. The development of pulmonary edema in patients with ARAS depends on the degree of hypertension and renal function. The pathogenesis of pulmonary edema in patients with ARAS has not been studied, and includes three basic mechanisms: impaired sodium excretion, development of diastolic dysfunction and impaired pulmonary alveolar−capillary barrier. Clinical features of Pickering syndrome is a rapidly increasing shortness of breath, passing in gasps. Duplex scanning with color Doppler mapping of the renal arteries is the screening test for detection of renal artery stenosis, renal angiography is a «gold standard». The first place of treatment of renovascular hypertension is occupied by an optimal drug therapy; recurrent pulmonary edema in patients with hemodynamically significant renal artery stenosis is indication for renal artery stenting. The question of renal artery stenting in patients with resistant hypertension and rapid decrease of kidney function is being discussed.
Key words: pulmonary edema, renovascular hypertension, Pickering syndrome, renal artery stenosis.