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.
– 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.