Research Viewpoints Acute Kidney Injury during Anti-Hypertensive Therapy

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Chen TK, Parikh CR: Management of Presumed Acute Kidney Injury during Hypertensive Therapy: Stay Calm and Carry on? Am J Nephrol DOI 10.1159/000505447

Several randomized and controlled studies have documented that “acute kidney injury” (defined by a rising level of serum creatinine) can accompany intensive blood pressure control regimens designed to achieve systolic blood pressure values <120 mm Hg. These studies have also documented that such lower blood pressure is associated with improved survival and a lower frequency of cardiovascular events.

Parikh and Chen critically examine this apparent paradox in a very well-written review article. They stress that much of the reduction of renal function seen in association with intensive blood pressure control is hemodynamic in nature and the designation of “acute kidney injury” cannot be justified in the absence of parameters directly supporting structural “kidney injury” per se. They suggest that when this hemodynamic phenomenon is encountered clinicians should “stay calm and carry on”. In this situation using changes in serum creatinine to define “acute kidney injury” is inappropriate. Good advice. Nephrologists using intensive anti-hypertensive regimens to gain better control of blood pressure will benefit from reading this timely and well-written article.