Lesson of the week: Bilateral renovascular disease causing cardiorenal failure

doi:10.1136/bmj.326.7387.489

BMJ 2003;326:489-491 ( 1 March )

Clinical review

Lesson of the week

Bilateral renovascular disease causing cardiorenal failure

Consider renovascular disease in patients with cardiorenal failure

Alison Brammah, staff grade nephrologist, Sue Robertson, staff grade nephrologist, Graeme Tait, consultant cardiologist, Chris Isles, consultant physician.

Renal Unit and Department of Cardiology, Dumfries and Galloway Royal infirmary, Dumfries DG1 4AP

Correspondence to: A Brammah
abrammah@hotmail.com

The first 150 words of the full text of this article appear below.

The association between heart failure and bilateral renovascular disease was first recorded in 1988 and has since been thesubject of numerous reports.^1-12 Acute or "flash" pulmonary oedemais most commonly described, but chronic heart failure can alsooccur. Heart failure is thought to arise when the kidneys, "protected"by bilateral stenoses, fail to mount a pressure natriuresis tohigh arterial pressure. The syndrome is therefore characterisedby fluid retention rather than ventricular failure. Clinical cluesinclude the association of cardiac and renal failure with hypertension,widespread vascular disease, inequality of renal size ( $>=$ 1.5 cmdifference) on ultrasonography, and a reversible increase in serumcreatinine concentrations after taking an angiotensin convertingenzyme inhibitor.¹³ A proportion of patients with this clinicalsyndrome may be cured by renal revascularisation. We report onsuch acase.

Case report

A 75 year old woman with moderate left ventricular systolic dysfunction after an inferior myocardial infarction required temporary. . . [Full text of this article]

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