반복적인 급성 폐부종으로 나타난 신동맥 협착의 내과적 치험

Renal artery stenosis is a rare cause of acute pulmonary edema. So-called flash pulmonary edema is associated with bilateral renal artery stenosis or stenosis in a single functioning kidney. Most patients have co-morbid cardiovascular disease and a renovascular etiology is overlooked. Flash pulmonary edema has been recognized as an absolute indication for vascular intervention. However, our case could be treated with medical treatment directiong a complete inhibition of renin-angiotensin system. A 81-year old man was admitted with acute shortness of breath. During that admission, despite the dialysis therapy for renal insufficiency, he had four severe episodes of acute pulmonary edema requiring mechanical ventilation. CT angiography showed bilateral renal artery stenosis. After administration of ACE inhibitor, angiotensin receptor blocker, and spironolactone, there was no further attack of pulmonary edema. (Korean J Nephrol 2003;22(4):474-478)