Pickering Syndrome precipitated by Angiotensin Converting Enzyme Inhibitor

Pramod Theetha Kariyanna^1, , Apoorva Jayarangaiah², Robert Adrah³, Abhishek Sharma⁴ and Debabrata Sen³

¹Department of Internal Medicine, State university of New York (SUNY)- Downstate Medical center, Brooklyn, New York, U.S.A.

²Department of Internal Medicine, Marshfield Clinic- St. Joseph Hospital, Marshfield, Wisconsin, U.S.A.

³Department of Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, New York, U.S.A.

⁴Division of Cardiology, Department of Internal Medicine, State university of New York (SUNY)- Downstate Medical center, Brooklyn, New York, U.S.A.

Cite this paper

Pramod Theetha Kariyanna, Apoorva Jayarangaiah, Robert Adrah, Abhishek Sharma and Debabrata Sen. Pickering Syndrome precipitated by Angiotensin Converting Enzyme Inhibitor. American Journal of Medical Case Reports. 2016; 4(1):31-34. doi: 10.12691/AJMCR-4-1-9

Abstract

Pickering syndrome is an under recognised cardio-renal syndrome where life threatening flash pulmonary edema develops in the setting of diastolic dysfunction of the heart. Renal artery stenosis induced activation of sympathetic nervous system and renin-angiotensin-aldosterone system result in fluid retention; such fluid retention in the setting of diastolic dysfunction results in flash pulmonary edema. Most patients who present with pickering syndrome have normal coronary circulation and left ventricular systolic function. We here present a case of pickering syndrome that was precipitated by initiation of angiotensin converting enzyme inhibitor therapy in a patient with undiagnosed unilateral renal artery stenosis. The incidence of flash pulmonary edema decreases on revascularization of renal artery stenosis. Underlying renal artery stenosis should be suspected in a patient with recurrent flash pulmonary edema as such patients merit from revascularization of renal artery stenosis. To the best of our knowledge we are the first to report angiotensin converting enzyme inhibitors as a precipitator of pickering syndrome.

Keywords

pickering syndrome, renal artery stenosis, diastolic dysfunction of heart, angiotensin converting enzyme inhibitors, renal artery revascularization

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Messerli FH, Bangalore S, Makani H, Rimoldi SF, Allemann Y, White CJ, Textor S, Sleight P. Flash pulmonary oedema and bilateral renal artery stenosis: the Pickering syndrome. Eur Heart J. 2011 Sep;32(18):2231-5.
[2]	Juggi JS1, Koenig-Berard E, Van Gilst WH, Cardioprotection by angiotensin-converting enzyme (ACE) inhibitors, Can J Cardiol. 1993 May; 9(4):336-52.
[3]	Gerstein H, Cardiovascular and Metabolic Benefits of ACE Inhibition,: moving beyond blood pressure reduction, Diabetes Care. 2000 Jul;23(7):882-3.
[4]	Taal M, Brenner B, Renoprotective benefits of RAS inhibition: From ACEI to angiotensin II antagonists, Kidney International (2000) 57, 1803-1817.
[5]	Schoolwerth A, Sica D, Ballermann B, Wilcox C, Renal Considerations in Angiotensin Converting Enzyme Inhibitor Therapy, A Statement for Healthcare Professionals From the Council on the Kidney in Cardiovascular Disease and the Council for High Blood Pressure Research of the American Heart Association, Circulation, 2001; 104: 1985-1991.
[6]	Safian RD, Textor SC. Renal-artery stenosis. N Engl J Med. 2001 Feb 8; 344(6):431-42.
[7]	Scoble JE. Renal artery stenosis as a cause of renal impairment: implications for treatment of hypertension and congestive heart failure. J R Soc Med. 1999 Oct;92(10):505-10.
[8]	Simon N, Franklin SS, Bleifer KH, Maxwell MH. Clinical characteristics of renovascular hypertension. JAMA. 1972 May 29;220(9):1209-18.
[9]	Vashist A, Heller EN, Brown EJ Jr, Alhaddad IA. Renal artery stenosis: a cardiovascular perspective. Am Heart J. 2002 Apr;143(4):559-64.
[10]	MacDowall P, Kalra PA, O'Donoghue DJ, Waldek S, Mamtora H, Brown K. Risk of morbidity from renovascular disease in elderly patients with congestive cardiac failure. Lancet. 1998 Jul 4;352(9121):13-6.
[11]	de Silva R, Nikitin NP, Bhandari S, Nicholson A, Clark AL, Cleland JG. Atherosclerotic renovascular disease in chronic heart failure: should we intervene? Eur Heart J. 2005 Aug;26(16):1596-605
[12]	Rundback JH, Murphy TP, Cooper C, Weintraub JL, Chronic renal ischemia: pathophysiologic mechanisms of cardiovascular and renal disease, J Vasc Interv Radiol. 2002 Nov; 13(11):1085-92.
[13]	Ritz E, Amann K, Fliser D. The sympathetic nervous system and the kidney: its importance in renal diseases. Blood Press Suppl. 1998; 3:14-9.
[14]	Mandinov L, Eberli FR, Seiler C, Hess OM. Diastolic heart failure, 813-825, 1 March 2000
[15]	Rimoldi SF, Yuzefpolskaya M, Allemann Y, Messerli F. Flash pulmonary edema. Prog Cardiovasc Dis. 2009 Nov-Dec; 52(3): 249-59.
[16]	Gavras H, Brunner HB, Vaughan ED, Laragh JH, Angiotensin-sodium interaction in blood pressure maintenance of renal hypertensive and normotensive rats. Science. 1973; 180: 1369-1371.
[17]	Messina LM, Zelenock GB, Yao KA, Stanley JC, Renal revascularization for recurrent pulmonary edema in patients with poorly controlled hypertension and renal insufficiency: a distinct subgroup of patients with arteriosclerotic renal artery occlusive disease. J Vasc Surg. 1992;15:73-80.
[18]	Avolio AP, Deng FQ, Li WQ, Luo YF, Huang ZD, Xing LF, O'Rourke MF. Effects of aging on arterial distensibility in populations with high and low prevalence of hypertension: comparison between urban and rural communities in China. Circulation. 1985 Feb;71(2):202-10.
[19]	Laurent S. Arterial wall hypertrophy and stiffness in essential hypertensive patients. Hypertension. 1995 Aug;26(2):355-62.
[20]	Roman MJ, Pickering TG, Schwartz JE, Pini R, Devereux RB, Relation of arterial structure and function to left ventricular geometric patterns in hypertensive adults, J Am Coll Cardiol. 1996 Sep; 28(3):751.
[21]	Grisk O, Rettig R. Interactions between the sympathetic nervous system and the kidneys in arterial hypertension. Cardiovasc Res. 2004 Feb 1;61(2):238-46.
[22]	Kawaguchi M, Hay I, Fetics B, Kass DA. Combined ventricular systolic and arterial stiffening in patients with heart failure and preserved ejection fraction: implications for systolic and diastolic reserve limitations. Circulation. 2003 Feb 11;107(5):714-20.
[23]	Ramanathan T, Skinner H. Coronary blood flow. Contin Educ Anaesth Crit Care Pain (2005) 5 (2): 61-64.
[24]	Rimoldi SF, Yuzefpolskaya M, Allemannemail Y, Messerli F, Flash Pulmonary Edema, November–December, 2009, Volume 52, Issue 3, Pages 249-259.
[25]	ThomasG. Pickering, RichardB. Devereux, GaryD. James, MichaelF. Silane, Lawrence Herman, JulioE. Sotelo, ThomasA. Sos, JohnH. Laragh, RECURRENT PULMONARY OEDEMA IN HYPERTENSION DUE TO BILATERAL RENAL ARTERY STENOSIS: TREATMENT BY ANGIOPLASTY OR SURGICAL REVASCULARISATION, Volume 332, No. 8610, p551-552, 3 September 1988.
[26]	Olin JW, Piedmonte MR, Young JR, DeAnna S, Grubb M, Childs MB. The utility of duplex ultrasound scanning of the renal arteries for diagnosing significant renal artery stenosis. Ann Intern Med. 1995 Jun 1;122(11):833-8.
[27]	Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM Jr, White CJ, White J, White RA, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American Association for Vascular Surgery; Society for Vascular Surgery; Society for Cardiovascular Angiography and Interventions; Society for Vascular Medicine and Biology; Society of Interventional Radiology; ACC/AHA Task Force on Practice Guidelines; American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; Vascular Disease Foundation. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic): executive summary a collaborative report from the
[28]	Bloch MJ, Trost DW, Pickering TG, Sos TA, August P, Prevention of recurrent pulmonary edema in patients with bilateral renovascular disease through renal artery stent placement. Am J Hypertens 1999;12:1-7.
[29]	Wierema TK, Yaqoob MM, Renal artery stenosis in chronic renal failure: caution is advised for percutaneous revascularization. Eur J Intern Med 2008;19:276-279.
[30]	Gray BH. Intervention for renal artery stenosis: endovascular and surgical roles. J Hypertens Suppl. 2005 Oct;23(3):S23-9.
[31]	Mackrell PJ, Langan EM III., Sullivan TM, Gray BH, Taylor SM, Cull DL, Snyder BA, Youkey JR, Carsten CGIII, Management of renal artery stenosis: effects of a shift from surgical to percutaneous therapy on indications and outcomes. Ann Vasc Surg 2003;17:54-59.