Hypertension and chronic kidney disease - Cause and consequence

The kidney is both a cause and victim of hypertension. High blood pressure is a key factor responsible for deterioration of kidney function. In cases of resistant hypertension the most common cause would be preexisting kidney disease, however it is often underappreciated. Chronic kidney disease (CKD) CKD is a progressive loss in kidney function over a period of months or years. Each of your kidneys has about a million tiny filters, called nephrons. If nephrons are damaged, they stop working. For a while, healthy nephrons can take on the extra work. But if the damage continues, more and more nephrons shut down. After a certain point, the nephrons that are left cannot filter your blood well and are less able to do the following jobs to help maintain health:

  • Remove wastes and extra fluid from your body
  • Release hormones that help to
Control blood pressure Promote strong bones Prevent anemia by increasing the number of red blood cells in your body Keep the right balance of important chemicals in your blood, such as sodium, potassium, phosphorus and calcium Maintain the body?s balance of acid and base. When your kidneys are not working well, wastes can build to high levels in your blood and make you feel sick. Even before that, you may develop complications like high blood pressure, anemia (low blood count), weak bones, poor nutritional health and nerve damage. Kidney disease also makes you more likely to develop heart and blood vessel disease. These problems may happen slowly, over a long period of time, often without symptoms. CKD may eventually lead to kidney failure requiring dialysis or a kidney transplant to maintain life. Early detection and treatment can prevent or delay these complications. Diabetes and hypertension are the common causes of chronic kidney disease. High blood pressure or hypertension Blood pressure is the force of your blood against the walls of your blood vessels as your heart pumps blood around your body. If this pressure becomes too high, you are said to have high blood pressure, or hypertension. How do know if your blood pressure is too high? The only way to tell if your blood pressure is too high is to have it measured. High blood pressure usually causes no symptoms. That is why it has been called a ?silent killer.? A single high reading may not mean you have high blood pressure. It should be confirmed on follow-up visits to your doctor or clinic. Normal blood pressure in adults 18 and older is less than 120/80. People, who have blood pressure between 120 and 139 for the top number, or between 80 and 89 for the bottom number, may be more likely to develop high blood pressure unless they take steps to prevent it. In general, blood pressure that stays at 140/90 or higher is considered high. However, for people who have diabetes or CKD, a blood pressure of 130/80 or higher is considered high. You have high blood pressure but not sure if you have CKD. What should you do? Everyone who has high blood pressure has an increased chance of developing CKD. You should ask your doctor about having the following tests:
  • A blood test for creatinine, a waste product from muscle breakdown: This should be used to calculate your glomerular filtration rate, or GFR. Your GFR is a measure of your level of kidney function. If your GFR is too low, it may mean your kidneys are not able to remove enough wastes and extra fluid from your blood.
  • A urine test for protein: Persistent protein in the urine is a sign of kidney damage.
  • A urine test to check for red blood cells and white blood cells
How are high blood pressure and kidney disease related? They are related in two ways: 1. High blood pressure is a leading cause of CKD. Over time, high blood pressure can damage blood vessels throughout your body. This can reduce the blood supply to important organs like the kidneys. High blood pressure also damages the tiny filtering units in your kidneys. As a result, the kidneys may stop removing wastes and extra fluid from your blood. The extra fluid in your blood vessels may build up and raise blood pressure even more. 2. High blood pressure can also be a complication of CKD. Your kidneys play a key role in keeping your blood pressure in a healthy range. Diseased kidneys are less able to help regulate blood pressure. As a result, blood pressure increases. Following your treatment plan and keeping your blood pressure controlled can help keep your kidney disease from getting worse and prevent heart disease. Things we can do to control hypertension and prevent kidney diseases
  • Exercising regularly
  • Eating a low-salt diet
  • Eat healthy and keep your weight in check
  • Adequate fluid intake
  • Monitoring blood pressure, cholesterol and glucose levels and keeping them in normal range
  • Taking your antihypertensive medications correctly as prescribed by your doctor
  • Not smoking
  • Avoiding non-steroidal anti-inflammatory drugs (NSAIDs) and other drugs which cause kidney damage
  • Getting your kidney function tests regularly
Dr. B. T. Anil Kumar, Consultant Nephrologist, BGS Global Hospitals        


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