Prevalence of renal artery stenosis in flash pulmonary oedema: Determination using gadolinium-enhanced MRA

Abstract Purpose 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. Materials and 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. Conclusion 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.