PS-C26-1: USEFUL MARKERS FOR RENAL PROGNOSIS IN HYPERTENSIVE EMERGENCIES WITH SEVERE RENAL DYSFUNCTION

Abstract

Background: Hypertensive emergencies are poor prognosis conditions associated with rapid blood pressure (BP) elevation and various organ damage. The frequency of dialysis induction due to nephrosclerosis is high and early detection and appropriate therapeutic intervention are important. Methods: We selected 15 patients diagnosed as hypertensive emergencies with severe renal dysfunction (serum creatinine level > 2.5 mg/dL) admitted to our hospital between 2005 and 2019. These were divided into two groups: those who received a renal replacement therapy (RRT) after 3 years and those who were not received (non-RRT). The clinical features and laboratory data between the two groups were reviewed and compared retrospectively. Results: The median age was 48 years old and the male to female ratio was 3:1. All the patients lacked medical examination and regular checkups after diagnosis of hypertension. 33% of them were obese with body mass index > 25. Six patients resulted in end-stage renal disease and received RRT. On admission, about 80% had elevated plasma renin activity and serum aldosterone levels, while there were no cases of renal artery stenosis. Between two groups, there was no significant difference in serum creatinine levels. Serum LDH levels in the non-RRT group were higher than those in the RRT group. Serum potassium levels and platelet counts were lower, respectively. These data at post-antihypertensive treatment was improved significantly in the non-RRT group. Serum values of LDH, potassium, and platelet in the comparison of pre-and post-treatment data of the two groups showed significantly improved by two-way analysis of variance. Discussion and Conclusion: The mechanism of the onset of hypertensive emergencies is still unclear. Severe hypertension causes severe vascular injury and multiple organ damages. In our study, there were young or middle-aged adults and some of them were obese. Therefore, taking health-checkup is helpful for the prevention of the risk of hypertension and appropriate treatment. Higher LDH levels and decreased platelet counts in the non-RRT group suggested the development of severe endothelial damage with rapid BP elevation in the short term. Severe renal dysfunction in these cases can be improved to some extent by appropriate antihypertensive therapy. Furthermore, the lower potassium level suggested the aggravation of the renin-angiotensin-aldosterone system (RAAS) and early induction of RAS inhibitors would be beneficial for the maintenance of BP and renal protection. In conclusion, the value of serum LDH, platelet count, and serum potassium would be predictors of renal prognosis.