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A patient with chronic kidney disease developed prerenal acute kidney injury due to low blood pressure after taking diuretics. The doctor reminded that antihypertensive drugs, diuretics and analgesics should be used with caution when dehydrated and should seek medical advice as soon as possible.
Mr Chen, 54, suffers from diabetes, high blood pressure and chronic kidney disease, and has been taking angiotensin receptor blockers for a long time. Recently, he went to the doctor for swelling in his legs and took diuretic medications. After a few days, his systolic blood pressure dropped below 100 mmHg, but he ignored it and continued taking the medicine. By the time I returned to the Nephrology Department of Taipei Tzu Chi Hospital for follow-up, blood tests found that creatinine had increased from 1.5 mg to 2.3 mg, indicating that kidney function had deteriorated.
Dr. Wu Zexiong of the Department of Nephrology performed an ultrasound examination of the kidneys and found no obvious obstruction in the urinary tract. Based on recent medication changes and test results, they determined that it was “prerenal acute kidney injury” caused by low blood pressure and inadequate renal perfusion. He immediately adjusted the medication and continued follow-up. Acute kidney injury refers to a sudden decline in kidney function over a short period of time. There are often no obvious symptoms in the early stages, and detection often requires blood tests, so it is easy to miss.
There are many causes of acute kidney injury. Among them, “prerenal” refers to insufficient blood flow to the kidneys. This is common in severe dehydration, heavy bleeding, sepsis, or heart failure. Some commonly used medications may also produce similar results at certain times. Dr. Wu Zexiong said the kidneys depend on adequate blood flow and pressure to filter blood. Among them, three types of drugs require special attention of the public.
The first category includes angiotensin-converting enzyme inhibitors and receptor blockers, which are antihypertensive drugs that can reduce intraglomerular pressure and burden, and have protective effects on patients with specific chronic diseases; However, dehydration or low blood pressure while taking medications may reduce filtration function. The second category is diuretics, which can help the body eliminate excess sodium and water. However, excessive urination or drinking insufficient water can lead to decreased blood volume.
The third category is non-steroidal anti-inflammatory analgesics, which are often used to relieve fever and pain. They can constrict the kidney’s afferent arteries and reduce blood flow. If these three types of drugs are used with dehydration, acute kidney injury can occur even in people with normal kidney function. The risk is higher for the elderly, patients with diabetes, high blood pressure, chronic kidney disease and physical weakness.
In clinical practice, it is more common for patients to suffer from dehydration due to vomiting, diarrhea, fever, and loss of appetite due to gastroenteritis, and they purchase painkillers themselves, which increases the burden on the kidneys. Dr. Wu Zexiong explained that the focus of the treatment of acute kidney injury is to identify and cure the cause as soon as possible. The doctor will evaluate whether to replenish fluids and adjust medications. Most patients have a chance to recover their kidney function. If not treated in time, it can lead to sustained damage, or even rapid deterioration in the condition and leading to kidney dialysis.
Dr. Wu Zexiong reminds that when vomiting, diarrhea, inadequate eating and drinking, or dehydration occurs, some medications may need to be temporarily discontinued. However, each patient’s situation is different, so you should confirm with your doctor first and not make any decisions on your own. You should develop the habit of measuring your blood pressure and weight. If you notice persistent low blood pressure, dizziness, weakness, significantly decreased urine output, or persistent vomiting, you should seek medical evaluation as soon as possible.
Summary FAQ
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When he returned to Taipei Tzu Chi Hospital for follow-up, they took blood and found that his creatinine had increased from 1.5 mg to 2.3 mg, indicating that his kidney function had deteriorated. After a renal ultrasound was performed to rule out an apparent blockage, the doctor determined that it was related to hypotension and inadequate renal perfusion.
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Prerenal acute kidney injury causes inadequate blood flow to the kidneys, resulting in a short-term reduction in filtering function. Common causes include severe dehydration, heavy bleeding, sepsis, heart failure, and may also be induced by certain medications in some circumstances.
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Doctors remind you to pay most attention to three types of medications: ACEI/ARB antihypertensive medications, diuretics, and nonsteroidal anti-inflammatory analgesics. If used at the same time and dehydration occurs, renal perfusion may be reduced and the risk of acute kidney injury may increase.
