Bilateral renal artery stenosis--a cause of acute pulmonary edema

Renal artery stenosis may present as acute pulmonary oedema and be misinterpreted as congestive heart failure. ACE inhibitors and angiotensin-II antagonists are widely used among patients with congestive heart failure and hypertension. The authors present a patient with congestive heart failure caused by a combination of coronary heart disease and bilateral renal artery stenosis. The patient developed acute kidney failure secondary to ACE inhibitor and angiotensin II antagonist treatment. Mechanisms behind pulmonary oedema secondary to renovascular hypertension are discussed. Revascularisation is the treatment of choice for this patient category.