[Medical Q&A] Can kidney disease cause high blood pressure?

Author: Cai Jun, Chief Physician, Fuwai Hospital, Chinese Academy of Medical Sciences

Reviewer: Wang Fang, Chief Physician, Beijing Hospital

Yes, kidney disease may cause high blood pressure!

Some high blood pressure can be clearly identified, which is called secondary hypertension. Renal hypertension is a common type of secondary hypertension. It is high blood pressure caused by kidney disease, such as acute or chronic glomerulonephritis, chronic pyelonephritis, kidney stones, polycystic kidney, renal artery stenosis, etc., which can all cause high blood pressure.

If you suspect that high blood pressure is caused by kidney disease, you need to have a careful examination. This includes testing blood urea nitrogen and creatinine, converting the glomerular filtration rate (GFR) to evaluate renal function; testing urine for microalbuminuria to reflect the severity of renal damage and monitor the progression of renal damage; for patients with reninoma, you also need to test the level of renin expression; for renal vascular hypertension with renal artery stenosis, imaging examinations are also required. Of course, the specific examination methods should be selected by the doctor based on the specific situation of the patient.

In terms of treatment, a comprehensive treatment plan should be formulated for the treatment of renal hypertension, including lifestyle adjustments, medications, surgery, etc. For example, get rid of bad habits such as smoking, alcoholism, and staying up late to eliminate their effects on physical health. In terms of drug treatment, when choosing antihypertensive drugs, the first choice is drugs that cause less damage to renal function, such as captopril, enalapril, losartan, valsartan, etc.; if renal function is impaired, nifedipine, furosemide, etc. can be used. Antihypertensive drugs usually start at a low dose. If a single drug cannot bring blood pressure to the standard, combination therapy should be actively used. In addition, for different kidney diseases, such as pyelonephritis, kidney stones, polycystic kidney disease, renal artery stenosis, etc., corresponding drug or surgical treatment should also be carried out.