Hi everybody, well I went for my yearly physical on Fri and my dr. did a urine test on me and said I'm starting to show signs of kidney damage from high BP, and that she has a 5 year window to get it down or else I would have to have kidney dialysis. That really freaked me out, to say the least. I asked for a renal specialist referral, but she wants to hold off on that for now...I am going back Aug 1 for BP check. I am on .1mg Clonidine twice daily..she said maybe she'd switch me to the patch because it releases med more gradually and continually throughout day. Just curious if anyone here with very high BP has this problem?
Hi, usually I don't see the BP boards. Today I just did that. Yes, high BP can cause kidney failure & even may need dialysis. How did that DOC know that you have kidney damage? It is easy to figure out. There are tests for 4 items.
Medical Tests of Kidney Function
Healthy kidneys remove wastes and excess fluid from the blood. Blood tests show whether the kidneys are failing to remove wastes. Urine tests can show how quickly body wastes are being removed and whether the kidneys are leaking abnormal amounts of protein.
Creatinine (kree-AT-uh-nin) is a waste product that comes from meat protein in the diet and from the normal wear and tear on muscles of the body. Creatinine levels in the blood can vary, and each laboratory has its own normal range. In many labs the normal range is 0.6 to 1.2 mg/dL. Higher levels may be a sign that the kidneys are not working properly. As kidney disease progresses, the level of creatinine in the blood increases.
Blood urea nitrogen (BUN):
Urea nitrogen (yoo-REE-uh NY-truh-jen) also is produced from the breakdown of food protein. A normal BUN level is between 7 and 20 mg/dL. As kidney function decreases, the BUN level increases.
Some urine tests require only a few ounces of urine. But some tests require collection of all urine produced for a full 24 hours. A 24-hour urine test shows how much urine your kidneys produce in 1 day. The test is sometimes used to measure how much protein leaks from the kidney into the urine in 1 day. However, protein leakage can also be accurately determined in a small sample of urine by measuring its protein and creatinine concentration.
A creatinine clearance test compares the creatinine in a 24-hour sample of urine to the creatinine level in the blood, to show how many milliliters of blood the kidneys are filtering out each minute (mL/min). The creatinine clearance can also be estimated accurately from the serum creatinine alone using well established prediction equations.
In addition to above 4 there is one more test. It is gloumelar filtration rate.
IN ALL OF THE ABOVE TESTS, THE NUMBERS must BE WITH IN THE NORMAL/PERMISSIBLE VALUES. OTHERWISE IT MAY LEAD TO kidney damage over time. These tests are vey simple & cheap. But it can provide valuable information.
WOW, thanks for the info!! My BP averages (on meds that don't work) around 150/95 but there were times when I've taken it and it was around 160/105. Highest spike at home was 197/112. Right now, on the Clonidine (and I'm almost done weaning off Atenolol) it seems to average around 130/83 which I am happy with of course. The doctor explained something to me about how high BP punches holes in the kidneys and that my urine showed some amounts of albumin (sp) being excreted...I was so scared by what she was telling me, all I remember is "the clock is ticking...I have a 5-year window to get it down...or else, you may have to have dialysis and you do NOT want to have that!!" I couldn't sleep or eat well for days after hearing that. When I called and asked to see a renal specialist, she said hold off for now. I go back Aug. 1 so I guess I will wait. I can't change docs right now because my insurance probably wouldn't pay for another physical this soon.
i do not think that you need to see a specialist. The same DOC can do some more tests to see how things other than albumin are doing. Yes you need to bring your BP to less than 140 most of the time. Even though DOC said that you may have kidney damage, I am surprized that the DOC did not prescribe new BP medication. Clonidine is not a ACE inhibitor class BP medications. All ACE inhibitor class of BP medication also protects KIDNEYs in addition to heart. It has been PROVEN from last 15-10 yrs that ACE class will absolutely protect the kidneys. Hence which ever DOC you go, tell him/her about ACE inhibitor class. Any ACE should by OK as long as it can bring down the BP to less than 140.
The newest classes of blood pressure medicines are angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). These medicines work to block the creation or function of a powerful hormone that raises blood pressure. There are many types of ACE inhibitors, such as lisinopril, captopril, enalapril, benazepril and fosinopril. Examples of ARBs include losartan, valsartan, irbesartan, candesartan, telmisartan and olmesartan. Both classes are very useful in patients with kidney disease and proteinuria (protein in the urine), as they help protect the kidney from further damage.
There are several classes of blood pressure medicines your doctor may prescribe. Each has different benefits and side effects. Although these medicines come in different doses and strengths, they all work equally well at lowering blood pressure.
The most important factor is to find medicines that effectively control your blood pressure that you can also tolerate. However, your doctor may prescribe a certain medication with extra benefits for your specific medical conditions.
A common class of blood pressure medicines is diuretics, or water pills. Common examples include hydrochlorothiazide (HCTZ) and furosemide. These medicines help kidneys remove excess salt and water from the body, which can lower blood pressure. Diuretics are effective in almost all patients. One common side effect is an increased need to go to the bathroom. These medicines have been around for a long time and are well studied. Most patients taking more than one blood pressure medicine should also be on a diuretic.
Another common class is beta-blockers. These medicines help slow the heart rate and decrease the strength with which the heart contracts. Examples include metoprolol, atenolol, labetalol and propranolol. Common side effects are fatigue, dry mouth and slowed heart rate. These medicines are very useful for patients with a history of heart attack or heart disease.
A newer class of blood pressure medicines is calcium channel blockers. This includes several very different medicines, including verapamil, diltiazem, felodipine, amlodipine and nifedipine. These medicines relax the blood vessels, thus lowering blood pressure. Side effects, which vary depending on the medicine, include ankle swelling, constipation and slowed heart rate. These medicines are very powerful in reducing blood pressure and are particularly useful in African Americans. They can be used along with any other class of blood pressure medicines.
Similar to calcium channel blockers, alpha-blockers also relax blood vessels and lower blood pressure. Doxazosin and terazosin are two commonly prescribed alpha-blockers. These medicines are particularly helpful for men with enlarged prostate glands, called benign prostatic hyperplasia (BPH), because they reduce the need to go to the bathroom. A common side effect is dizziness or lightheadedness, especially when rising from a sitting position.
The newest classes of blood pressure medicines are angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). These medicines work to block the creation or function of a powerful hormone that raises blood pressure. There are many types of ACE inhibitors, such as lisinopril, captopril, enalapril, benazepril and fosinopril. Examples of ARBs include losartan, valsartan, irbesartan, candesartan, telmisartan and olmesartan. Both classes are very useful in patients with kidney disease and proteinuria (protein in the urine), as they help protect the kidney from further damage. They also offer special protective effects for patients with congestive heart failure or a weak heart. ARBs have very few side effects but are generally more expensive than ACE inhibitors. Side effects from ACE inhibitors include a chronic, dry cough and, more importantly, angioedema, swelling of the tongue, lips or face. Although angioedema is rare, it can be life threatening and should be reported to your doctor immediately.
Finally, there are a number of other medicines your doctor may prescribe, such as clonidine, hydralazine or minoxidil. Each of these works differently, but all are effective at lowering blood pressure. Clonidine can cause drowsiness, fatigue and dry mouth; hydralazine can cause a rash. Side effects caused by minoxidil include fluid retention, swelling, and increased facial hair growth.
Thus, there are many types and classes of blood pressure medicines. Depending on a number of factors, including your medical conditions, age, race and cost, your physician will come up with a specific plan for you. Each patient is different, and medicines that may help one patient may not be best for others. It is important to work with your physician, because there might be some trial and error involved in selecting the best and most effective medicines. Often times, medicines will need to be stopped due to side effects or because they are not working well enough. However, with continued work and patience, a truly effective combination of medicines can be found for almost every patient. For many patients, this may be just one or two medicines, but other patients may require three or four. Again, the most important issue is to find medicines that work to appropriately control your blood pressure while causing the fewest side effects possible.
Yes, I've tried all the different classes of BP meds, been going back to my doc over a year now trying to find the right one, but maybe it is a combination of drugs that I need. She reassured me not to get frustrated, as there are over 200 different kinds of meds to try. Again, thanks for sharing your knowledge on this.
phd 1993, may I ask you a question about my lab results? I haven't really gotten much information from my doctor, and what I read seems contradictory. One test showed slight microalbumin in my urine, but a normal albumin/creatinine ratio. ( I had the microalbumin tested again, but have not received the results.) My BUN is normal as are other numbers in my metabolic profile. However, I had a GFR done (estimated) and it was down 15%, indicating a stage 2 kidney disease. This information doesn't add up to me. The doctor suggested an ACEI or an ARB, and I'm willing to take one. However, so far I haven't been able to tolerate the side effects from the drugs I've tried in either groups. My blood pressure is in the normal to prehypertensive range. Any insight you could give would be greatly appreciated. I have a doctor's appointment in a couple of months, but there never seems to be enough time in an appointment to satisfy my endless need for information! Thanks.
The reason why is because the kidneys consume an enormous amount of blood- 15% of the total blood in circulation. The kidneys' elaborate system of nephrons and tubules work to create urine by maintaining certain pressures. Higher pressures than normal can cause severe damage in the long run to these delicate vessels. Also, consistently low blood pressure during shock after an injury can cause kidney failure- this time because the kidneys aren't receiving the vast supply of blood that they require. Good luck and God bless!
"Not everything that steps out of line, and thus 'abnormal,' must necessarily be 'inferior.'"
I understand the basic physiology of the kidney, so see how high blood pressure can damage the nephrons and lead to leakage. However, my blood pressure is around 120/80 and sometimes lower. Also, I would expect a build up of creatinine, but the levels are normal. No kidney injury either. If the second microalbumin test comes out positive, then I suspect mild diabetic nephropathy. But an isolated positive for microalbumin doesn't indicate kidney damage. However, I also read that stage 1 & 2 kidney disease can show up in the absence of kidney damage or high blood pressure--how or why is where I'm lost.