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PATHOGENESIS OF RECURRENT PULMONARY EDEMA IN PATIENTS WITH ATHEROSCLEROTIC OCCLUSIVE LESIONS OF RENAL ARTERIES

https://doi.org/10.24884/1561-6274-2007-11-1-55-63

Abstract

THEAIM of the work was to establish causes of the development of recurrent pulmonary edema (RPE) in patients with atherosclerotic occlusive lesions of the renal arteries (AOLRA) on the basis of an analysis of the observations, treatment and literature data. PATIENTS AND METHODS. Among 82 AOLRA patients under examination there were 5 (6%) patients with RPE. All of them had bilateral hemodynamically significant AOLRA, including occlusion of one of the renal arteries, high arterial hypertension, pronounced renal failure (serum Cr from 0.16 to 0.43 mmol/l, GFR by MDRD from 9 to 32 ml/min) and symmetrical hypertrophy of the left ventricle (LV) myocardium with its pronounced diastolic dysfunction, but saved ejection fraction (from 48 to 61%). RESULTS. Three patients after revascularization of the kidneys had steadily decreased AP, improved (stable) renal function and no RPE in the early and long-term periods. The other two patients without surgical intervention died. CONCLUSION. RPE in AOLRA patients was found to be pathogenetically due to chronic renal ischemia, but realized by different mechanisms: higher pressure in the capillaries of the lesser circulation owing to diastolic dysfunction of LV caused by acute raising AP; by sodium and water retention due to activation of the rennin-angiotensin-aldosteron system and/or azotemia, increased permeability of the alveolar-capillary membrane of the lungs. The elimination of renal ischemia by revascularization of the kidneys is the only method of effective treatment of RPE in AOLRA patients.

About the Authors

N. A. Yaitsky
Санкт-Петербургский государственный медицинский университет им. И.П.Павлова
Russian Federation


A. M. Ignashov
Санкт-Петербургский государственный медицинский университет им. И.П.Павлова
Russian Federation


A. V. Smirnov
Санкт-Петербургский государственный медицинский университет им. И.П.Павлова
Russian Federation


V. A. Dobronravov
Санкт-Петербургский государственный медицинский университет им. И.П.Павлова
Russian Federation


D. V. Semenov
Санкт-Петербургский государственный медицинский университет им. И.П.Павлова
Russian Federation


A. A. Kurkov
Санкт-Петербургский государственный медицинский университет им. И.П.Павлова
Russian Federation


E. P. Turobova
Санкт-Петербургский государственный медицинский университет им. И.П.Павлова
Russian Federation


V. F. Li
Санкт-Петербургский государственный медицинский университет им. И.П.Павлова
Russian Federation


T. Yu. Zlochevskay
Санкт-Петербургский государственный медицинский университет им. И.П.Павлова
Russian Federation


S. V. Fiyas
Санкт-Петербургский государственный медицинский университет им. И.П.Павлова
Russian Federation


V. E. Trubkin
Санкт-Петербургский государственный медицинский университет им. И.П.Павлова
Russian Federation


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Review

For citations:


Yaitsky N.A., Ignashov A.M., Smirnov A.V., Dobronravov V.A., Semenov D.V., Kurkov A.A., Turobova E.P., Li V.F., Zlochevskay T.Yu., Fiyas S.V., Trubkin V.E. PATHOGENESIS OF RECURRENT PULMONARY EDEMA IN PATIENTS WITH ATHEROSCLEROTIC OCCLUSIVE LESIONS OF RENAL ARTERIES. Nephrology (Saint-Petersburg). 2007;11(1):55-63. (In Russ.) https://doi.org/10.24884/1561-6274-2007-11-1-55-63

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ISSN 1561-6274 (Print)
ISSN 2541-9439 (Online)