{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T00:07:43Z","timestamp":1792886863203,"version":"4.5.0"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,10,3]]},"abstract":"<jats:p xml:lang=\"en\">ABSTRACTRecurring and rapidly developing (flash) pulmonary edema is the hallmark of Pickering syndrome, affecting patients with hypertension and atherosclerotic renal artery stenosis (either bilateral or unilateral) in a solitary functioning kidney, and impaired renal function. We herein report on a series of consecutive patients with recurrent hospital admissions for pulmonary edema, impaired renal function (chronic kidney disease class 4\u20135), and atherosclerotic bilateral renal artery stenosis, in whom Pickering syndrome had been long neglected. We also describe a streamlined diagnostic strategy entailing little or no need for contrast medium, thus carrying no risks of further worsening of renal function. This allowed us to make the correct diagnosis and opened the way to revascularization by percutaneous transluminal renal angioplasty with stent, which provided swift recovery of kidney function with resolution of pulmonary congestion and long\u2010term pulmonary edema\u2010 and dialysis\u2010free survival in all cases. In summary, these findings support the following key messages: (1) considering the diagnosis of Pickering syndrome, followed by searching atherosclerotic renal artery stenosis, is an essential step toward a life\u2010saving revascularization that avoids dialysis and an otherwise poor outcome; and (2) a simplified strategy entailing little or no need for contrast medium, carrying no associated risks of deteriorating renal function, permits the diagnosis of Pickering syndrome.<\/jats:p>","DOI":"10.1161\/jaha.123.030474","type":"journal-article","created":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T11:58:44Z","timestamp":1695729524000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":22,"title":["Pickering Syndrome: An Overlooked Renovascular Cause of Recurrent Heart Failure"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4735-1636","authenticated-orcid":false,"given":"Viola","family":"Sanga","sequence":"first","affiliation":[{"name":"Hypertension and Emergency Unit, Department of Medicine University of Padua Padua Italy"},{"name":"PhD Arterial Hypertension and Vascular Biology, Department of Medicine University of Padua Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8258-9052","authenticated-orcid":false,"given":"Eleonora","family":"Bertoli","sequence":"additional","affiliation":[{"name":"Hypertension and Emergency Unit, Department of Medicine University of Padua Padua Italy"},{"name":"PhD Arterial Hypertension and Vascular Biology, Department of Medicine University of Padua Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6822-1430","authenticated-orcid":false,"given":"Filippo","family":"Crim\u00ec","sequence":"additional","affiliation":[{"name":"Hypertension and Emergency Unit, Department of Medicine University of Padua Padua Italy"},{"name":"Institute of Radiology, Department of Medicine University of Padua Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1157-3635","authenticated-orcid":false,"given":"Giulio","family":"Barbiero","sequence":"additional","affiliation":[{"name":"Institute of Radiology, Department of Medicine University of Padua Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Battistel","sequence":"additional","affiliation":[{"name":"Institute of Radiology, Department of Medicine University of Padua Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3639-4086","authenticated-orcid":false,"given":"Teresa Maria","family":"Seccia","sequence":"additional","affiliation":[{"name":"Hypertension and Emergency Unit, Department of Medicine University of Padua Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7963-0931","authenticated-orcid":false,"given":"Gian Paolo","family":"Rossi","sequence":"additional","affiliation":[{"name":"Hypertension and Emergency Unit, Department of Medicine University of Padua Padua Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(88)92668-2"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehr056"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2009.10.002"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001063"},{"key":"e_1_3_2_6_2","first-page":"67","article-title":"Renal failure related to angiotensin\u2010converting enzyme inhibitors","volume":"17","author":"Textor SC","year":"1997","unstructured":"Textor SC. 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