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Atherosclerotic renal artery stenosis with flash pulmonary edema — ABIM Board MCQ

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HardNephrologyAtherosclerotic renal artery stenosis with flash pulmonary edemaABIM Board

A 71-year-old woman has recurrent flash pulmonary edema and resistant hypertension. Creatinine rises from 1.1 to 1.8 mg/dL after starting lisinopril. Duplex ultrasound suggests bilateral high-grade renal artery stenosis. Which of the following is the most appropriate management?

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Correct answer: B — Consider renal artery revascularization in addition to optimized medical therapy

Most atherosclerotic renal artery stenosis is managed medically, but recurrent flash pulmonary edema, refractory hypertension, or progressive renal dysfunction in bilateral disease are scenarios where revascularization may provide benefit.

Reference: AHA Renovascular Disease Scientific Statement; ACC/AHA Hypertension Guideline