An ‘ACE’ of a Test
A 57-year-old cardiac transplant recipient was admitted for the management of heart failure. He had severe graft coronary arteriosclerosis and normal left ventricular systolic function. In addition, the patient had hypertension and diabetes mellitus. During the hospitalization, enalapril was initiated for the control of hypertension. A progressive increase in the serum creatinine level was observed (A), raising a suspicion of renal artery stenosis. The enalapril was discontinued, with a subsequent decrease in serum creatinine. A periumbilical bruit was audible on abdominal auscultation. The patient underwent magnetic resonance angiography, which demonstrated a severe stenosis of the right renal artery (B, arrows) and a severe stenosis or total occlusion of the left renal artery (C, arrow). Subsequent evaluation by renal artery contrast angiography (D) confirmed the magnetic resonance angiographic findings. The patient underwent successful bilateral renal artery angioplasty.
ACE inhibitors can precipitate acute renal failure in patients with bilateral renal artery stenosis, but renal function is quickly restored on discontinuation of the drug. Magnetic resonance angiography my be a useful noninvasive screening test for the presence of renal artery stenosis, allowing for the identification of patients who will benefit from revascularization.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner, MC 4-265, Houston, TX 77030.
- Copyright © 1997 by American Heart Association