What are the possible kidney problems that would cause high blood pressure in a 25-year-old female? My daughter has had high blood pressure for over a year now and her medicine has not been controlling it. They ran blood tests, did a kidney ultrasound and urinalysis last week, and called today to say there was a problem with her kidney blood test. She is going out of town and they couldn’t see her until next week and they would not discuss it with her over the phone.
Hypertension is one of the most common of the serious cardiovascular problems facing people who live in industrialized societies, and because it usually causes no symptoms, it is one of the most insidious. There have been many public health campaigns to try to educate people about hypertension and its serious effects, and the lowered death rates from heart attacks and strokes that we have seen in this country during the past 20 years probably are a result, at least in part, of those campaigns.
In many populations hypertension is found in 50 percent of adults. African Americans are more commonly and severely affected. Most hypertension is what we call “essential” hypertension, meaning that its cause is not known. A small number of cases, probably 5 percent or less of all hypertensives, has “secondary” hypertension, that is, the increased blood pressure develops because of another disease. Kidney disease is the most common group of conditions causing secondary hypertension.
There are certain signs that should tip off a doctor treating someone with hypertension to the possibility that the person has secondary hypertension. One is young age; hypertension is usually a disease of middle-aged or older persons. Other clues are severe hypertension and hypertension that is difficult to control.
The kidneys play a very important role in regulating the total volume of fluid and salt in the body. Any condition that interferes with the kidneys’ ability to regulate salt and volume will cause hypertension, and it can be extremely important to find out if there is underlying kidney disease, since in some cases this can be cured, and the hypertension will disappear.
From the information given by today’s letter writer, I cannot tell what type of kidney disease her daughter has, but it is not surprising that her doctor looked for and found some form of kidney disease, since her daughter is young, and her hypertension has been difficult to control. Glomerulonephritis, which can be acute or chronic, is a common kidney disease leading to hypertension. Also, anything that partially blocks the artery or arteries going to the kidneys may cause it, and this can often be corrected surgically. Polycystic kidneys, an inherited type of kidney disease, will often cause hypertension. Diabetic kidney disease is a very common condition associated with hypertension.
Hypertension itself can cause kidney disease, even kidney failure, so in someone who has been hypertensive for years, kidney disease may develop and may make the hypertension more difficult to control, but in such a case it is the hypertension that is causing the kidney disease, not vice versa. The daughter of today’s writer clearly does not fit into this category.
The treatment of hypertension has benefited from the development of many new drugs in the past 30 years, and the disease should be controllable in any person with proper medication. Bringing the blood pressure down to or below 140/90 will usually prevent the complications of strokes, heart attacks or kidney failure which caused so many deaths in the past. A diabetic who also has hypertension has to be particularly careful in controlling the blood pressure, and many authorities recommend that it be maintained at a level of 130/80 or less specifically to protect the person’s kidneys from damage.