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Urology (Expert Forum)
Uncontrolled High Blood Pressure causing Kidney Failure
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Uncontrolled High Blood Pressure causing Kidney Failure
by Cascade Cowgirl, Mar 23, 2004 12:00AM
I have had uncontrolled BP between 140 & 220 Syst for since Jan.'02. Kidney failure showed in June '03. Drs. are assuming I have Kidney failure because of HBP. No Biopsy. Diast around 50 & steady. I'm salt & caffeine free since Jan.02. No alcohol, tobacco, excess wt.or lack of exercise. They've been increasing dosage as my BP goes up. Is it becoming resisant to the meds? I take 800 mg Labetalol, 340 Diovan, .2 Clonidine, 40 Furosemide daily. I cough from ACE inhibitors, swell from Norvasc & Hydralazine floored me. What other meds can I add to this or change? What more can I do to lower my BP and keep it down. Other than the obvious common sense remedies.
My createnine goes between 1.7 & 2.0 for the last year. BUN between 38 & 58. I've been getting Epogen shots every 3 wks since July '03...that part of the kidneys failed first. But why? Is that a clue? Could there be another reason for my kidney failure?
I've had an angiogram, MRI, Echo. No obvious reason for HBP or kidney failure. I realize I have a few questions in here, but they're all related. I have to lower my BP to slow the kidney failure. I need to get the pieces of this puzzle put together in the right order. I can live with 1.7 createnine, but it won't stay down if the BP doesn't. I'm doomed if I don't get my BP down & keep it down forever. I hope I haven't left anything out. Let me know & I'll re-do it.
My createnine goes between 1.7 & 2.0 for the last year. BUN between 38 & 58. I've been getting Epogen shots every 3 wks since July '03...that part of the kidneys failed first. But why? Is that a clue? Could there be another reason for my kidney failure?
I've had an angiogram, MRI, Echo. No obvious reason for HBP or kidney failure. I realize I have a few questions in here, but they're all related. I have to lower my BP to slow the kidney failure. I need to get the pieces of this puzzle put together in the right order. I can live with 1.7 createnine, but it won't stay down if the BP doesn't. I'm doomed if I don't get my BP down & keep it down forever. I hope I haven't left anything out. Let me know & I'll re-do it.
Doctor's Answer
by Kevin Pho, MD, Mar 24, 2004 12:00AM
, Mar 24, 2004 12:00AM
WHen blood pressure becomes difficult to control despite high doses of several medications, the you have to look for other (i.e. "secondary") causes of hypertension.
Possible causes indeed can include kidney disease, renovascular disease, pheochromocytomas or other endocrine abnormalities.
I would assume with the angiogram and MRI/MRA, your doctors have already suspected renovascular hypertension - if not, an evaluation for this disease should be done.
A pheochromocytoma is an andrenal tumor that is associated with hypertension. A screen for this would include a urine tests looking for increased hormone secretion.
If everything is negative, then renal disease can itself cause hypertension. Further tests, including a kidney biopsy, should be considered.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Possible causes indeed can include kidney disease, renovascular disease, pheochromocytomas or other endocrine abnormalities.
I would assume with the angiogram and MRI/MRA, your doctors have already suspected renovascular hypertension - if not, an evaluation for this disease should be done.
A pheochromocytoma is an andrenal tumor that is associated with hypertension. A screen for this would include a urine tests looking for increased hormone secretion.
If everything is negative, then renal disease can itself cause hypertension. Further tests, including a kidney biopsy, should be considered.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
