Overview
Hypertensive renal failure refers to acute kidney injury secondary to severe hypertension, often leading to progressive renal dysfunction and potentially end-stage renal disease 1.Diagnosis
Elevated blood pressure readings consistent with hypertension
Evidence of acute kidney injury (elevated serum creatinine, decreased estimated glomerular filtration rate [eGFR])
Exclusion of other causes of acute kidney injury through urinalysis, renal ultrasound, and potentially renal biopsy
Monitoring of metabolic parameters, including thiamine levels in patients with end-stage renal failure 1Management
Blood pressure control: Initiate antihypertensive therapy targeting a reduction in blood pressure to levels consistent with renal protection (e.g., ACE inhibitors or ARBs, if renal function allows) 1
Fluid management: Adjust fluid intake and consider diuretics to manage fluid overload 1
Thiamine supplementation: Consider in patients with end-stage renal failure on dialysis to prevent or manage potential thiamine deficiency contributing to encephalopathy 1
Dialysis: Initiate hemodialysis if there is refractory fluid overload, metabolic disturbances, or progressive renal failure 1Special Populations
End-stage renal failure: Increased vigilance for metabolic complications like thiamine deficiency leading to encephalopathy 1Key Recommendations
Monitor and manage thiamine levels in patients with end-stage renal failure presenting with encephalopathy, as thiamine deficiency may exacerbate neurological symptoms (Evidence: Weak) 1
Initiate appropriate antihypertensive therapy to control blood pressure in hypertensive renal failure, prioritizing agents that offer renal protection (Evidence: Expert opinion) 1
Consider early initiation of dialysis in cases of refractory fluid overload or severe metabolic disturbances (Evidence: Expert opinion) 1References
1 McGarvey C, Franconi C, Prentice D, Bynevelt M. Metformin-induced encephalopathy: the role of thiamine. Internal medicine journal 2018. link