Hypertension management in acute kidney injury

Abstract

Despite the fact that in recent years the concept of hypertension treatment has been verified and the management in special situations and groups of patients has been standardized , there are not many reports of antihypertensive therapy in patients with acute kidney injury. Acute renal failure, defined as a sudden decline of kidney function, is a clinical syndrome of various etiologies, often accompanies by hypertension, and specific pathological mechanism determines the therapeutic management. Diuretics are first-line drugs, particularly preferred in patients with volume overload. RAA blockers are not recommended for the hypertension treatment in acute kidney injury, but the broad definition of AKI forces individualization of therapy in various clinical situations - the results of large clinical trials show the benefits of ACE inhibitors in cases of HTA associated with acute glomerulopathies or vasculitis. Prevalence of drugs that affect potassium levels contribute to the rising incidence of hyperkalemia, which can be a consequence of both — acute and chronic kidney diseases. In case of a dynamically growing levels of potassium in AKI there is a need to decrease the dose or withdrawal of RAA blockers and mineralocorticoid antagonists.