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Abstract: TH-PO238

Resistant Hypertension with Recurrent Flash Pulmonary Edema in the Setting of Bilateral Renal Artery Occlusion

Session Information

Category: Hypertension and CVD

  • 1602 Hypertension and CVD: Clinical


  • Karabulut, Korin, Boston University, Boston, Massachusetts, United States

Resistant hypertension is defined as elevated blood pressure despite three different classes of anti-hypertensives and warrants thorough investigation to rule out underlying secondary causes.Renal artery occlusion is an uncommon pathology, which can lead to severe kidney damage and can present with non-specific symptoms such as hematuria, acute kidney injury, uncontrolled hypertension.

Case Description

49-year-old male with past medical history of unprovoked pulmonary embolism, recurrent flash pulmonary edema, hypertension, stage 4 chronic kidney disease with nephrotic range proteinuria who presented with shortness of breath, back pain and claudication symptoms. On presentation, he was found to have hypertensive emergency with flash pulmonary edema, requiring nicardipine infusion and mechanical ventilation. Initial laboratory tests were remarkable for hypokalemia, elevated creatinine, 4 g/g proteinuria on dipstick and microscopic hematuria. Anti-PLA2r, ANA, serum and urine electrophoresis, ANCA, serum and urine metanephrines were unrevealing. Patient had prior renal biopsy showing collapsing glomerulopathy with chronic renal thrombotic angiopathy. As the patient was hemodynamically stabilized, secondary causes for hypertension were investigated. Renal doppler ultrasound was performed, showing abdominal aorta thrombosis at the level of juxtarenal to infrarenal segments with bilateral occlusion of renal arteries. These findings furthermore confirmed with MR-Angiogram and renal nuclear scans. Given the life debilitating claudication symptoms, the patient underwent right axillobifemoral bypass.


Recurrent flash pulmonary edema and resistant hypertension should raise suspect for renovascular hypertension and potentially renal artery occlusion. Renal artery occlusion is a rare finding and can be seen in patients with trauma, endovascular interventions, atherosclerosis, thromboembolic events and possibly underlying hypercoagulability. After ruling out lupus anticoagulants, antiphospholipid panel, Factor Leiden V, homocysteine, trauma and we concluded that the renal artery occlusion was due to atherosclerotic plaque proved by pathology. While the treatment is on case-on-case basis, revascularization was pursued for our patient with resolution of claudication symptoms but no significant improvement of kidney functions.