Kidney Disease (Nephropathy) in Hypertension: Causes, Symptoms & Treatment

High blood pressure sometimes occurs for a short period of time. However, if the levels are permanently higher than normal, a doctor must be consulted. Kidney disease, such as nephropathy, can be the result of untreated high blood pressure.

What is kidney disease (nephropathy)?

Kidney disease (nephropathy) occurs in patients who have high blood pressure and do not have it treated or have it treated inadequately. Because kidney function and blood pressure interact, chronic renal insufficiency develops as a secondary disease. On the one hand, blood pressure is regulated by the hormone secretion of the kidney. On the other hand, the kidney is responsible for fluid balance in the body. The interaction of both factors thus determines blood pressure. If there is permanent high blood pressure, the vascular system within the kidney can be damaged. But damage to the kidney can also be the cause of high blood pressure. Kidney disease initially goes unnoticed. The lower the kidney function becomes, the more complaints arise. Initially, patients experience fatigue and have less appetite. Headaches with nausea and vomiting may occur. In addition, there is also storage of tissue fluid (edema), combined with itching of the skin. This may have a bronze-colored appearance. As a result, anemia (anemia) and heart failure occur with kidney disease.

Causes

The cause of kidney disease is the slow calcification of the kidney vessels. If this occurs in the large vessels in addition to the small capillaries, the kidney no longer receives an adequate blood supply. It compensates for this condition by secreting a larger quantity of hormones, which, however, also causes the blood pressure to rise further. The smaller kidney vessels increasingly lose their stability. The protein concentration in the urine is increased because the kidney, which is damaged in this way, can no longer perform its function and filter the protein accordingly.

Symptoms, complaints, and signs

Kidney disease (nephropathy) in hypertension usually progresses without symptoms at the beginning. Only the high blood pressure may cause nonspecific complaints, if any. The patient then sometimes suffers from headaches, dizziness, visual disturbances or tightness in the chest area. But chronic high blood pressure also often goes unnoticed because it does not always lead to symptoms. Kidney damage is usually diagnosed only by chance at this stage. Laboratory tests reveal elevated concentrations of proteins in the urine. For years, the constant breakdown of kidney tissue can always be compensated for by its regeneration. Only the tissue hardens, so that nephrosclerosis develops. If hypertension is left untreated, kidney damage progresses to the point where symptoms eventually develop. Due to impaired kidney function, sufferers then experience fatigue, exhaustion, poor performance, excruciating itching all over the body, and headaches. In addition, nausea, vomiting and loss of appetite may occur. The skin becomes a milky coffee or bronze color. Water may accumulate in the lungs. This often results in severe shortness of breath. The disease can lead to complete kidney failure. The patient either requires lifelong dialysis. In severe cases, a kidney transplant may also be necessary. With severe blood pressure fluctuations, kidney failure can also occur suddenly with states of confusion, nausea, vomiting, coma or even seizures and heart failure. This is a very serious emergency situation that can quickly lead to death.

Diagnosis and course

Kidney disease, such as nephropathy, is first diagnosed by the doctor by analyzing the urine. The more protein present in it, the more advanced the damage to the kidney. By taking the patient’s medical history, the physician first obtains additional information about the patient’s other complaints, which are indicative of kidney disease and can be confirmed by a subsequent laboratory test. In a healthy person, there should be less than 20ml/l protein in the urine. Values between 20 and 200 mg/l indicate microalbuminuria and thus incipient kidney disease. Values above this indicate advanced kidney disease. The blood test provides further information on kidney function.Additional organ damage, such as to the eyes and heart, must be ruled out if kidney disease is diagnosed.

Complications

When kidney disease (nephropathy) is caused by high blood pressure, without treatment a vicious cycle can develop in which both the nephropathy and the high blood pressure continue to rise. This usually leads to serious complications. As mentioned earlier, hypertension is a cause of nephropathy. The kidney vessels are calcified and can no longer be supplied with sufficient blood. As the organism attempts to improve blood flow to the kidneys, blood pressure is increased even further. However, the increased blood pressure exacerbates the already existing kidney disease and, in extreme cases, can lead to kidney failure with subsequent need for dialysis. If the high blood pressure is not treated, there is also a risk of total failure of one or even both kidneys. However, it is not only the kidneys that are affected. The ever-increasing blood pressure also poses the risk of developing serious cardiovascular diseases. This increases the risk of heart attacks or strokes. However, complications of kidney disease (nephropathy) associated with high blood pressure can be very well avoided by early treatment of high blood pressure. If there is already kidney dysfunction due to high blood pressure, blood pressure should be lowered to a level of 130/80 mmHg to prevent progression of kidney disease. If the kidneys are already severely damaged, even this blood pressure value is still too high. To prevent further impairment of kidney function, the blood pressure value must then ideally be lowered below 125/75 mmHg in addition to treatment of the nephropathy.

When should you go to the doctor?

If kidney disease is suspected, a doctor must always be consulted immediately. If such disorders are not recognized and treated in time, there is a risk of acute kidney failure. Moreover, if treatment is given too late, the organ is often so severely damaged that the patient is dependent on dialysis, i.e. artificial blood washing. Kidney disease should therefore always be presented to a doctor promptly. However, kidney disease associated with high blood pressure is treacherous, as there are usually no symptoms at the beginning. At most, the patient will notice evidence of the hypertension itself. Signs may include dizziness, visual disturbances, or nonspecific headaches. Some patients also experience a feeling of tightness in the chest. Anyone who frequently notices such symptoms should consult a doctor as a precaution. In the advanced stage, more specific symptoms also become noticeable in nephropathy with high blood pressure. Typical, for example, is excruciating itching all over the body. Nausea, vomiting and discoloration of the skin are often also present. At the latest then a doctor must be consulted immediately. The symptoms should not be treated with over-the-counter medications, as this can cause additional damage to the kidney.

Treatment and therapy

Kidney disease due to hypertension requires adjustment of blood pressure to optimal levels. If renal function is already impaired, blood pressure values should not reach higher than 130/80 mmHg to prevent further impairment of renal function. If severe kidney disease is already present, blood pressure must be lowered even further. Values of 125/75 mmHg and below are considered ideal in this case. There are five different groups of active ingredients in the drugs that are usually prescribed to lower blood pressure. However, because of the kidney damage suffered by patients, only drugs from the ACE inhibitor group and AT1 antagonists are considered for treatment. Regular monitoring of blood and urine values and, of course, of the stability of blood pressure values are subsequently necessary. If the patient’s condition worsens due to the progression of the kidney disease and kidney function is severely impaired, the kidney function must be replaced by permanent dialysis (blood washing). Subsequently, kidney transplantation may be necessary, as dialysis and its side effects are a major burden in daily life for patients with kidney disease.

Outlook and prognosis

The further course of the disease in the present condition depends on the intensity and length of the existing symptoms due to blood pressure. In the case of short-term and transient hypertension, often no doctor is consulted.Existing health impairments are therefore not adequately diagnosed. If high blood pressure occurs repeatedly over a long period of time, it can have long-term consequences for the entire organism. Without medical care, the further outlook for these sufferers is significantly worsened. There is a gradual decline in physical and mental strength. In addition to possible damage to the tissue, other symptoms can occur that have a negative impact on the general well-being. Impaired vision or headaches lead to further complications or irregularities in coping with everyday life. States of confusion or comatose developments may result. If the disease progresses unfavorably, the affected person may face premature death at an advanced stage. Damage to the kidney can lead to functional disorders of the organ. If no long-term therapy, dialysis or transplantation of a donor organ takes place, life expectancy is considerably reduced. In addition, the affected person may die prematurely from sudden heart failure. The stresses of high blood pressure can cause organ damage to the heart, triggering an emergency situation.

Prevention

Kidney disease can be prevented by checking blood pressure regularly. If blood pressure levels are persistently too high, treatment must be given as soon as possible. Regular monitoring by a physician is also important in the case of preexisting kidney disease, since the risk of developing other diseases of the cardiovascular system is correspondingly increased in this group of patients. In daily life, attention should be paid to a low-salt diet.

Follow-up

Depending on how the nephropathy has affected the kidneys, various forms of follow-up care are necessary. If the disease was detected and treated relatively early, regular use of antihypertensive medications is usually sufficient for patients. Unless serious side effects occur, regular follow-up examinations are not necessary. If, as a result of the nephropathy, kidney function has already been reduced or it has even been necessary to remove a kidney, intensive follow-up is necessary. The focus here is on the patient’s adaptation to the reduced renal performance. During the follow-up examinations, it is checked whether the remaining kidney capacity is sufficient to filter the blood adequately. To do this, a doctor takes a blood sample and determines the levels of nutrients such as calcium and of waste products. If the levels found are too high, patients need to adjust their lifestyle. Weight loss, a change in diet and light exercise are often the first measures to be taken. But habits such as smoking, excessive consumption of alcohol or sweets may also have to be abandoned. If there is no improvement despite appropriate drug treatment and lifestyle adjustments, a kidney transplant may be necessary. After such a surgical procedure, patients receive therapy tailored to them to avoid overusing the new kidney as much as possible.

Here’s what you can do yourself

In the case of nephropathy caused by high blood pressure, patients themselves can do a great deal to improve their condition. If the affected person has been prescribed antihypertensive drugs, then it is of utmost importance that these are also taken regularly and exactly as prescribed. In addition, it is usually necessary for patients to adjust their lifestyle in order to reduce the risk of high blood pressure. Patients with a BMI of 25 or higher urgently need to reduce their weight. If this cannot be achieved alone, an ecotrophologist or nutritionist should be consulted. Some sufferers also benefit from self-help groups, which exist in all major cities. In addition, there are now also numerous offers of help for overweight people on the Internet. Regular physical exercise is also of central importance. On the one hand, sport helps patients to lose weight and avoid gaining it back. In addition, endurance sports in particular have a direct positive effect on blood pressure. Four to five exercise sessions per week lasting at least 30 minutes are recommended.In addition to cycling and swimming, brisk walks and regular climbing of stairs are particularly suitable. In the gym, strength exercises should be avoided and endurance trained instead. Alcohol and cigarettes are counterproductive.