Hypertension-Induced Chronic Kidney Disease

Hypertension, or high blood pressure, is often referred to as the 'silent killer' because it typically produces no noticeable symptoms until it has already caused significant damage to organs, including the heart, brain, and kidneys. It affects more than one billion people worldwide and remains one of the leading modifiable risk factors for cardiovascular disease and chronic kidney disease (CKD).

Long-term elevation of blood pressure directly injures the small blood vessels (arterioles) within the kidneys. This leads to thickening and narrowing of the vessel walls, which is a process called arteriolosclerosis. This results in reduced blood flow to the glomeruli.

Over time, the glomeruli become scarred and sclerotic (hypertensive nephrosclerosis), the filtering units lose function, and progressive fibrosis replaces healthy kidney tissue. Proteinuria often appears, and glomerular filtration rate (GFR) steadily declines, eventually progressing to end-stage renal disease in many untreated cases.

Although hypertension is considered a traditional cause of CKD in many medical classifications, the mechanisms involved (endothelial dysfunction, oxidative stress, inflammation, and activation of the renin-angiotensin-aldosterone system) mirror those seen in non-traditional or toxin-induced forms of kidney injury. Uncontrolled hypertension accelerates kidney damage independently of other factors such as diabetes.

Large epidemiological studies have consistently demonstrated the strong link. For instance, data from national registries show that individuals with hypertension are at substantially higher risk of developing CKD compared with normotensive controls, with risk increasing in a dose-dependent manner according to blood pressure levels[1][2].

We propose to call this Chronic Kidney Disease of non-Traditional causes (CKDnT): Hypertension-Induced Chronic Kidney Disease.

[1] Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group: KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease in Kidney International – 2021
[2] Mills et al: Global Disparities of Hypertension Prevalence and Control in Circulation – 2016