Flash Pulmonary Edema, as Collateral Damage

Three randomized controlled trials failed to show definite outcome benefits of percutaneous renal artery stenting compared to aggressive medical therapy in patients with poorly controlled hypertension, unexplained chronic kidney disease, or both associated with atherosclerotic renal artery stenosis ≥ 50%. Besides resistant hypertension and unexplained chronic kidney disease, atherosclerotic renal artery stenosis is a well-recognized non-primary cardiac cause of recurrent hyperacute “flash” pulmonary edema that percutaneous renal artery stenting routinely alleviates in observational studies. Other conditions than atherosclerotic renal stenosis may cause recurrent pulmonary edema although they do not present as acutely as atherosclerotic renal artery stenosis-mediated pulmonary edema presents. The findings of a positive, randomized, controlled trial of percutaneous renal artery stenting in patients with bilateral renal artery stenosis- or unilateral renal stenosis with contralateral renal impairment- mediated flash pulmonary edema may provide the needed support for thorough investigation and aggressive treatment of patients with flash pulmonary edema.