Current Concepts! Renal Autoregulation

Dr. Biff Palmer, nephrologist and clinician researcher extraordinaire has published a great piece in NEJM about renal autoregulation, creatinine, anti-HTN agents and renal dysfunction. Fantastic read!

Just a few points:
– with chronic HTN and chronic renal disease, the intraglomerular to MAP (or renal perfusion) curve becomes more linear – and anti-HTN therapy can lead to decreases in intraglomerular pressure for chronic renal disease patient that would not affect a normal person. See Figure 1.

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– Chronic renal failure, even small declines in the glomerular filtration rate will lead to an increase in the serum creatinine  concentration
– In many patients, this initial decline in renal function will either improve or resolve with long-term control of the blood pressure.
– Allowing blood-pressure control to deteriorate in order to prevent a rise in the creatinine concentration can harm the very patients who benefit most from tight blood-pressure control, which has bee proved to slow the progression of chronic renal failure.

NEJM Creatinine and BP

http://www.nejm.org/doi/full/10.1056/NEJMra020676