Kidney Issues and Hypertension: Causes and Symptoms Explained

Kidney and Hypertension

Hello Dr.
Chen, last year I inquired about renal artery stenosis.
After a cardiac catheterization, it was found that there is no stenosis in the left renal artery, but the left kidney is smaller, which seems more like a congenital issue rather than atrophy.
I have been continuously monitoring my hypertension, which has been between 120-139/80-90.
However, recently, due to changes in the weather, my blood pressure has suddenly increased to 125-155/75-100.
I am currently taking Concor and have added Plendil, but my blood pressure remains unstable, fluctuating between high and low.
The symptoms are quite pronounced: my pulse has increased from 65-90 to 80-110, and I am experiencing arrhythmias, frequent urination (for over 10 years), nocturia (for over a year and a half), along with occasional palpitations, tinnitus, dizziness, shoulder pain, headaches, insomnia, constipation, nausea, and alternating hot and cold sensations in my hands and feet.
Could this be related to renal failure, a cardiac issue, or simply a result of hypertension? Thank you.

Nanping, 40~49 year old female. Ask Date: 2008/03/04

Dr. Chen Junji reply Urology

Dear Mr.
Nanping,
Hello! If your smaller kidney size is due to congenital renal hypoplasia and kidney function is normal, there is no need for excessive concern; regular monitoring is sufficient.
Regarding hypertension, it is important to emphasize the need for consistent medication adherence and ongoing control, with an ideal target average blood pressure of below 130/85 mmHg.
If blood pressure increases due to weather changes and there are no accompanying symptoms, there is no need to self-medicate or increase the dosage to avoid unnecessary side effects and risks.
Concor and Plendil are long-acting antihypertensive medications that provide a gradual but sustained effect, and they are not suitable for treating hypertensive emergencies.
Self-adjusting the medication may lead to cumulative dosing and a subsequent risk of hypotension.
I recommend that you keep a record of your blood pressure readings to share with your outpatient physician for regular medication adjustments.
Additionally, since you have multiple non-specific symptoms, it is advisable to consult your outpatient physician for a thorough evaluation of potential conditions or medication side effects.

Reply Date: 2008/03/04

More Info

Understanding the relationship between kidney issues and hypertension is crucial for managing health effectively. Hypertension, or high blood pressure, can be both a cause and a consequence of kidney problems. In your case, the fluctuation in blood pressure readings, along with the symptoms you are experiencing, warrants a thorough evaluation.

Causes of Hypertension Related to Kidney Issues
1. Renal Artery Stenosis: Although your previous tests indicated no stenosis in the left kidney, renal artery stenosis can still be a factor in hypertension. This condition occurs when the arteries supplying blood to the kidneys become narrowed, leading to reduced blood flow. The kidneys respond by releasing hormones that increase blood pressure.

2. Chronic Kidney Disease (CKD): If there is any underlying kidney dysfunction, it can lead to fluid retention and increased blood pressure. Your history of frequent urination and nocturia may suggest some level of kidney impairment, which could be contributing to your hypertension.

3. Hormonal Factors: The kidneys play a significant role in regulating blood pressure through the renin-angiotensin-aldosterone system (RAAS). If there is an imbalance in this system due to kidney issues, it can lead to elevated blood pressure.

Symptoms and Their Implications
The symptoms you mentioned—irregular heartbeat, palpitations, dizziness, and headaches—can be associated with both hypertension and potential kidney dysfunction. For instance:
- Palpitations and Irregular Heartbeat: These can be caused by high blood pressure or electrolyte imbalances, which may arise from kidney issues.

- Dizziness and Headaches: These symptoms can be indicative of hypertension itself or may result from inadequate blood flow to the brain due to fluctuating blood pressure.

- Frequent Urination and Nocturia: These symptoms can be linked to kidney problems, particularly if the kidneys are not filtering waste effectively.

Treatment Recommendations
1. Medication Management: You are currently on Concor (bisoprolol) and Plendil (felodipine), both of which are effective antihypertensives. However, if your blood pressure remains unstable, it may be necessary to reassess your medication regimen. It’s crucial to work closely with your healthcare provider to find the right balance.

2. Lifestyle Modifications: Implementing lifestyle changes can significantly impact blood pressure control. This includes:
- Diet: A low-sodium diet can help reduce blood pressure. Incorporating more fruits, vegetables, and whole grains while limiting processed foods is beneficial.

- Exercise: Regular physical activity can help lower blood pressure and improve overall cardiovascular health.

- Stress Management: Given your anxiety about blood pressure fluctuations, incorporating stress-reducing techniques such as mindfulness, yoga, or deep-breathing exercises may help.

3. Regular Monitoring: Keeping a log of your blood pressure readings and symptoms can provide valuable information for your healthcare provider. This can help in adjusting your treatment plan as needed.

4. Further Evaluation: Given the complexity of your symptoms, it may be beneficial to undergo additional tests, such as kidney function tests (e.g., serum creatinine, GFR) and possibly imaging studies to assess kidney structure and function.

Conclusion
In summary, the interplay between kidney health and hypertension is intricate and requires careful management. Your symptoms could stem from a combination of factors, including hypertension, potential kidney dysfunction, and possibly anxiety. It is essential to maintain open communication with your healthcare provider, adhere to prescribed treatments, and make lifestyle adjustments to improve your overall health. Regular follow-ups will be crucial in managing your condition effectively.

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