KYDNEY DISFUNTION AND HYPERTENSION – BEYOND THE OBVIOUS

Abstract

Chronic kidney disease (CKD) is defined as the presence of an estimated glomerular filtration rate (eGFR) of less than 60mL/min/1.73m2 for 3 or more months, regardless of the cause. KDIGO (Kydney Disease Improving Global Outcomes) stages G3 to 5 have a prevalence of about 10% in the adult population. The risk factors that contribute the most to its onset and progression are arterial hypertension (HTN) and diabetes mellitus, and their control is essential for the prevention of CKD.

We present the case of a 48-year-old melanodermic male, with a known history of type II diabetes, poorly controlled hypertension, CKD stage KDIGO G3a (baseline creatinine 1.6 mg/dL, eGFR 48mL/min/1.73) and obesity.
He was referred to the HTN consult due to grade 3 hypertension, under 3 antihypertensive drugs plus a diuretic. The investigation of secondary causes and characterization of target organ damage were carried out. A2 albuminuria, increased urinary protein/creatinine ratio (241.7 mg/gr) and protein electrophoresis with increased gamma globulins were observed. Serum immunofixation detected a monoclonal IgG peak. Multiple myeloma was hypothesized and confirmed by myelogram and bone biopsy. Referred to Clinical Hematology, being without disease progression and under surveillance. The blood pressure profile is controlled with 4 antihypertensive plus a diuretic.

This case aims to alert for the need to investigate secondary causes of HTN in certain clinical conditions, namely in the presence of resistant HTN and worsening of renal function with proteinuria, even in patients probably with essential HTN. Moreover, this case, highlights the relationship and etiology of CKD and HTN. The “obvious” would be CKD as a consequence of diabetic and hypertensive nephropathy, however, the diagnosis may have worsened not only the CKD, but also the HTN itself. The doubt remains, since there is no hematological indication for active treatment.