Bilateral renal artery stenosis causing cardio

Renal artery Stenosis is narrowing or blockage of the artery that supplies blood to the kidneys. It is caused by atherosclerosis fibro muscular dysplasia of the renal arterial wall, or scar formation in artery. The association between heart failure and bilateral renovascular disease was first recorded in 1988 and has since been the subject of numerous reports. The outcome in Renal artery Stenosis seem to vary; some patients with severe proximal artery lesions maintain well preserved renal function, yet others with lesser lesion can still progress to end stage renal disease. Acute or flash pulmonary oedema is well described entity but chronic heart failure can also occur. Heart failure is thought to arise when the kidneys, protected by bilateral stenosis, fail to mount a pressure natriuresis to high arterial pressure. The syndrome is therefore characterized by fluid retention rather than ventricular failure. Clinical clues include the association of cardiac and renal failure with hypertension, wide spread vascular disease, inequality of renal size (>1.5cm difference) on USG, and a reversible increase in serum creatinine concentration on taking ACE inhibitiors.Department of Cardiology SKIMS hospital, Srinagar, India sam_4334@yahoo.co