Renal Hypertension After Kidney Injury: Causes and Solutions

Renal hypertension

Hello, doctor.
Six months ago, I had a car accident that resulted in a left renal laceration with a hematoma measuring approximately 11 centimeters.
I underwent conservative treatment for self-repair, and now, after six months, the hematoma has reduced to about 4 centimeters (initially located on the lateral side of the kidney).
I have no discomfort symptoms, but my blood pressure has been abnormally elevated, with systolic readings often between 135 and 150, and diastolic readings between 87 and 110.
My blood pressure remains high even before bedtime.
I have regular health check-ups every year, and my height is 157 cm with a weight of 43 kg.
Aside from anemia, all other blood test results are normal.
I do not exercise, but my diet and daily routine have not changed significantly.
After being discharged, my blood pressure was normal for the first couple of months, but now I have suddenly discovered high blood pressure and I am unsure how long it has been ongoing.
I am very concerned that this could have serious implications.
Could this be related to the renal artery? If we rule out renal factors, can high blood pressure develop suddenly in the short term? Which specialty should I consult, or what tests should I undergo to determine the cause? I am really worried! Thank you!

Eva, 30~39 year old female. Ask Date: 2021/02/08

Dr. Li Han reply Cardiology

Regarding your inquiry about "recent abnormal increases in blood pressure, with systolic readings often between 135 and 150 and diastolic readings between 87 and 110, which remain elevated even before bedtime," and considering your history of a left renal laceration and hematoma from a car accident six months ago, you are wondering if this could be related to the renal artery.
"Which specialty should I consult or what tests should I undergo to determine the cause? I am really worried!"
Before discussing the diagnosis of hypertension, it is recommended that you start measuring and recording your home blood pressure accurately.
Given the fluctuations in blood pressure, measure it at least twice and take the average.
Schedule a consultation with a cardiologist, and during your visit, use an automatic blood pressure monitor available in the clinic.
Additionally, bring your home blood pressure monitor for comparison.
Please provide the recorded measurements for the consulting physician's reference.
Furthermore, arrange to engage in consistent moderate-intensity exercise, such as brisk walking or climbing small hills, aiming for a total of 150 minutes per week, and try to reduce stress in your daily routine.

Take care, and the Changhua Hospital of the Ministry of Health and Welfare is concerned about your well-being.

Reply Date: 2021/02/08

More Info

Renal hypertension, or high blood pressure resulting from kidney issues, can be a complex condition, especially following a traumatic injury like a kidney laceration. In your case, the history of a significant kidney injury and the presence of a hematoma (blood clot) can indeed contribute to elevated blood pressure.

Causes of Renal Hypertension Post-Injury
1. Renal Artery Stenosis: After a kidney injury, there can be scarring or changes in the renal artery that may lead to narrowing (stenosis). This can reduce blood flow to the kidney, prompting the body to release hormones that increase blood pressure to maintain adequate perfusion.

2. Hormonal Changes: The kidneys play a crucial role in regulating blood pressure through the renin-angiotensin-aldosterone system (RAAS). An injury may disrupt this balance, leading to increased renin production, which raises blood pressure.

3. Fluid Retention: If kidney function is compromised, the body may retain more fluid, which can increase blood volume and subsequently raise blood pressure.

4. Pain and Stress Response: The body’s response to pain and stress can also elevate blood pressure. Even if you are not experiencing discomfort, the body may still react to the injury.

Diagnostic Approach
Given your situation, it is essential to take a systematic approach to identify the underlying cause of your hypertension:
1. Consult a Nephrologist: A nephrologist specializes in kidney-related issues and can provide a comprehensive evaluation of your kidney function and blood pressure regulation.

2. Imaging Studies: An ultrasound or CT scan of the kidneys can help assess for any structural changes, such as renal artery stenosis or residual effects from the hematoma.

3. Blood Tests: Regular monitoring of kidney function through serum creatinine and blood urea nitrogen (BUN) levels is crucial. Additionally, checking electrolytes and hormone levels related to the RAAS can provide insights into the cause of hypertension.

4. Ambulatory Blood Pressure Monitoring: This involves wearing a device that measures your blood pressure at regular intervals over 24 hours. It can help determine if your hypertension is persistent or if it fluctuates significantly.

5. Urine Tests: A urinalysis can help identify any abnormalities, such as proteinuria, which may indicate kidney damage.

Management Strategies
1. Lifestyle Modifications: While you mentioned no significant changes in diet or activity, consider adopting a heart-healthy diet low in sodium and rich in fruits, vegetables, and whole grains. Regular physical activity can also help manage blood pressure.

2. Medications: If lifestyle changes are insufficient, your doctor may prescribe antihypertensive medications. ACE inhibitors or ARBs are often preferred in patients with kidney issues as they can provide renal protection.

3. Regular Monitoring: Given your history, regular follow-up appointments to monitor blood pressure and kidney function are essential. This will help catch any changes early and adjust treatment as necessary.

Conclusion
In summary, your elevated blood pressure could be related to the kidney injury and its aftermath. It is crucial to seek evaluation from a nephrologist who can guide you through the necessary tests and management strategies. Early intervention is key to preventing long-term complications associated with uncontrolled hypertension, including further kidney damage and cardiovascular issues. Don't hesitate to reach out for medical advice and support; managing your health proactively is the best approach.

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