Hypertension in kidney disease

At a glance

• Kidney disease is the commonest secondary cause of hypertension, and in Australia and NZ hypertension and renovascular disease are the third commonest cause of kidney failure, after diabetes and glomerulonephritis (ANZDATA; hypertension ranks second in US data). Each worsens the other.
• Renal parenchymal hypertension comes from sodium retention, RAAS activation and sympathetic overactivity. It affects most people with CKD G4 and nearly everyone on dialysis.
• Renovascular hypertension is atherosclerotic in about 90% (older, vascular disease) and fibromuscular dysplasia in most of the rest (mostly women, from young adulthood to middle age).