Pickering Syndrome Manifesting as Recurrent Pulmonary Edema in an Older Woman With Renal Artery Stenosis

Abstract

Pickering syndrome, characterized by recurrent episodes of flash pulmonary edema (FPE) and renal impairment, is associated with renal artery stenosis (RAS). This case highlights its manifestation and management in an older adult patient. An 86-year-old woman with hypertension, chronic kidney disease, and a single functioning kidney presented with recurrent FPE episodes. Imaging revealed severe left RAS and an atrophic right kidney. Despite initial medical management, recurrent episodes of pulmonary edema led to renal angioplasty with stent placement. Follow-up imaging revealed restenosis in the left renal artery, necessitating a second angioplasty. The patient’s condition stabilized after intervention, with improvement in both cardiac and renal function. This case illustrates the critical importance of considering RAS in patients with recurrent FPE and resistant hypertension and emphasizes timely diagnosis and intervention. Early detection and intervention in Pickering syndrome can prevent recurrent pulmonary edema and renal failure.