Renal artery atherosclerosis presenting in the setting of heart failure — including acute decompensated heart failure and acute pulmonary edema — is a clinically significant and frequently underrecognised combination that warrants a specific management approach.
Atherosclerotic renal vascular disease is highly prevalent in heart failure: it occurs in 34% of acute hospitalizations with systolic heart failure among patients over 70 years of age, and in 54% of heart failure cases in outpatients with chronic kidney disease.
In patients presenting with acute pulmonary edema or decompensated heart failure, a revascularization strategy is among the interventions to consider — the full protocol details the specific indications and stepwise management.
ARVD is highly prevalent in HF, occurring in 34% of acute hospitalizations with systolic HF in patients aged >70 years and in 54% of cases of HF in outpatients with CKD.
Case reports show that improvement in cardiac structure and function can occur with renal artery revascularization in patients with high-grade stenosis, suggesting that this should be considered in patients presenting with acute pulmonary edema.
DOI: 10.1053/j.ajkd.2021.06.025 View source ↗