Acute cardiorenal decompensation in the setting of chronic renal artery stenosis treated with successful renal artery stenting. A case report

Nehaal Ahmed; Jose Arriola-Montenegro; Saad Rashid; Ian R McPhail; Benjamin Bizer; Iasmina M Craici; Samy M Riad

doi:10.47487/apcyccv.v6i4.515

Authors

Nehaal Ahmed Division of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA. https://orcid.org/0009-0006-5314-9281
Jose Arriola-Montenegro Department of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA. https://orcid.org/0000-0001-6921-7230
Saad Rashid St. George’s University College of Medicine, True Blue, Grenada.
Ian R McPhail Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Benjamin Bizer Department of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA. https://orcid.org/0009-0003-5430-1810
Iasmina M Craici Department of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.
Samy M Riad Department of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA. https://orcid.org/0000-0001-5737-9742

DOI:

https://doi.org/10.47487/apcyccv.v6i4.515

Keywords:

Renal Artery Obstruction, Hypertension, Pulmonary Edema, Acute Kidney Injury, Angioplasty, Balloon

Abstract

Atherosclerotic renal artery stenosis may present with resistant hypertension, hypertensive crisis, ischemic nephropathy, and cardiac destabilization. Although early studies of renal artery stenting showed promise, later trials found no benefit over medical therapy—yet often excluded high-risk, acute cases. We describe an 85-year-old male with cardiovascular risk factors who developed a hypertensive crisis, acute kidney injury, and flash pulmonary edema. An angiogram revealed severe ostial right renal artery stenosis. Stenting resulted in the rapid resolution of the acute crisis and restoration of baseline renal function. This case underscores the potential benefit of revascularization in select high-risk presentations of renal artery stenosis.

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