International Journal of Advances in Nephrology Research

C1q-Associated Nephropathy in a Patient with Prior Acute Interstitial Nephritis and Treated Hepatitis C Infection

Harsha Makhija, Aswathy Joseph, Apoorva Parmar, Sumesh Nirwan, Yogesh Tanwar — Fri, 02 Jan 2026 00:00:00 +0000

C1q nephropathy (C1qN) is an uncommon glomerular disorder defined by dominant mesangial deposition of complement component C1q on immunofluorescence in the absence of clinical or serological evidence of systemic lupus erythematosus (SLE). It classically presents with nephrotic syndrome and shows variable light microscopic appearances that may mimic minimal change disease (MCD) or focal segmental glomerulosclerosis (FSGS). We report a 48-year-old male farmer with a history of biopsy-proven acute interstitial nephritis (AIN) and previously treated hepatitis C virus (HCV) infection who presented with nephrotic-range proteinuria, severe hypoalbuminemia, and marked dyslipidemia. Renal biopsy demonstrated dominant mesangial C1q positivity with trace IgG, C3, and light chains, while electron microscopy revealed electron-dense deposits confined exclusively to the mesangium. The patient was started on high-dose corticosteroids (prednisolone 1 mg/kg/day) as per KDIGO adult nephrotic syndrome recommendations, achieved complete remission by four weeks, and is currently maintained on a six-month tapering schedule. This case highlights the importance of differentiating C1qN from mimics and suggests a potential link between antecedent immune insults and mesangial immune complex disease.

Renal Spectrum of Sjögren’s Syndrome: A Case of Secondary Membranous Nephropathy

Thu, 15 Jan 2026 00:00:00 +0000

Sjögren’s syndrome (SS) is a systemic autoimmune disease primarily affecting exocrine glands, but with potential multisystem involvement. Renal involvement in Sjögren’s syndrome are uncommon and mostly presenting as tubulointerstitial nephritis and less frequently with glomerular involvement. We report a case of a 19-year-old female who was diagnosed to be a case of primary Sjögren’s syndrome who presented with nephrotic-range proteinuria, anasarca, and acute kidney injury severe enough to require renal replacement therapy. She also had classical sicca symptoms, arthralgia, and immunology work up was positive for anti nuclear antibody, anti-SSA and anti-SSB confirming the presence of Sjögren’s syndrome The patient’s EULAR Sjögren's syndrome disease activity index (ESSDAI) score was 10 based on the involvement of glandular(xerostomia), renal (proteinuria and renal dysfuction) and articular domains (arthralgia without synovitis).Despite moderate ESSDAI score, owing to the presence of renal dysfunction and proteinuria ,renal biopsy was performed which demonstrated membranous nephropathy with diffuse capillary wall thickening and granular IgG1/IgG4 deposition. Immunohistochemistry and serology were negative for known membranous nephropathy antigens, including PLA2R, THSD7A, NELL-1, and EXT1, supporting a diagnosis of secondary membranous nephropathy associated with Sjögren’s syndrome. Treatment with corticosteroids and mycophenolate mofetil resulted in significant improvement in renal function and proteinuria and the patient became dialysis-independent. This case highlights an unusual renal manifestation of Sjögren’s syndrome in a young patient and signifies the importance of renal biopsy for accurately diagnosing renal involvement, even when systemic disease activity score falls in moderate category as per ESSDAI. It also raises the possibility of yet unidentified antigenic targets in Sjögren’s syndrome–associated membranous nephropathy.

Venous Excess Ultrasound and Adverse Renal and Clinical Outcomes in Acute Heart Failure and Critical Illness: A Systematic Review and Meta-analysis

Syrym Alika, Xiao Yang, Han Yu Wang, Jing Zhang, Zhiyong Peng — Mon, 11 May 2026 00:00:00 +0000

Background: Venous Excess Ultrasound (VExUS) is increasingly used as a bedside tool to assess systemic venous congestion, but its prognostic value for renal deterioration and short-term clinical outcomes in acute heart failure and critical illness remains uncertain. We conducted a systematic review and meta-analysis to evaluate the association between VExUS or related venous congestion ultrasound constructs and adverse renal and mortality outcomes.

Methods: This systematic review and meta-analysis was prospectively registered in PROSPERO (CRD420261366890). PubMed, Embase, and other major databases were systematically searched from database inception to 2020 for prospective observational studies evaluating formal VExUS or related venous Doppler-based congestion assessments in acute heart failure or critical care settings. The primary quantitative synthesis was restricted to studies using formal VExUS and reporting comparable AKI/WRF-type renal outcomes. Risk of bias was assessed using the Quality in Prognosis Studies tool.

Results: Thirteen prospective observational studies involving 1,210 participants were included. Study populations, ultrasound exposure definitions, scan timing, and outcome definitions were heterogeneous. In the primary renal meta-analysis, higher formal VExUS burden was associated with directionally higher odds of adverse renal outcomes, although the estimate was imprecise and heterogeneity was substantial (5 studies; pooled OR 2.85, 95% CI 0.60–13.43; I² = 79.0%). For short-term mortality, formal VExUS data from 3 studies showed a similarly adverse but highly imprecise association (pooled OR 2.64, 95% CI 0.02–310.14; I² = 87.8%). Non-poolable outcomes, including MAKE30 and organ dysfunction, generally showed worse outcomes among patients with greater venous congestion burden.

Conclusions: Higher VExUS burden may be associated with adverse renal and short-term clinical outcomes in acute heart failure and critical illness. However, current evidence remains limited by observational study design, small pooled datasets, substantial heterogeneity, and imprecision. Standardized VExUS acquisition protocols, exposure thresholds, and outcome definitions are needed to clarify its prognostic role and potential clinical utility.

Gender and Age Variations in Biomarkers of Diabetic Nephrotoxicity in a Nigerian Teaching Hospital: KIM-1, Cystatin C and Microalbuminuria

Ibitoroko Maureen George-Opuda, Achor Chor Joyce Chituru, Helen Waribo — Mon, 12 Jan 2026 00:00:00 +0000

Background: Early detection of diabetic nephropathy (DN) is crucial for preventing its progression to chronic kidney disease. While biomarkers like Kidney Injury Molecule-1 (KIM-1), Cystatin C, and microalbuminuria aid in identifying renal injury, gender- and age-related variations are poorly characterised in Nigerian populations.

Objective: To investigate the influence of gender and age on the levels of KIM-1, Cystatin C, and microalbuminuria in diabetic patients attending a Nigerian teaching hospital.

Methods: This was a cross-sectional study involving diabetic adults. Blood and urine samples were analysed for KIM-1, Cystatin C, and microalbuminuria using ELISA and immunoturbidimetric methods. Participants were stratified by gender and by age groups (26–35, 36–45, 46–55, 56–65, 66–75 years).

Results: Older participants exhibited significantly higher levels of KIM-1, Cystatin C, and microalbuminuria (p<0.05). Males had higher KIM-1 and Cystatin C levels than females, suggesting a greater tubular damage burden. Microalbuminuria was consistently elevated across both genders. Age positively correlated with all biomarkers, indicating increased renal vulnerability with advancing age. Significant correlations were observed between the early biomarkers and traditional renal parameters, confirming their utility in detecting subclinical injury.

Conclusion: Gender and age significantly influence biomarkers of diabetic nephrotoxicity. The elevation of KIM-1 and Cystatin C was pronounced among older males. These findings support targeted, biomarker-based screening to improve the early identification of diabetic kidney injury and enable timely intervention.

Biochemical Assessment of Diabetes Nephropathy in Newly Diagnosed Diabetes Mellitus Patient in Ogbomoso

Tolulope Adebola Olalere, Ayobola Abolape Iyanda, Joel Olufunminiyi Akande — Thu, 15 Jan 2026 00:00:00 +0000

Background: Diabetes mellitus is a major global health concern, and its complication, diabetic nephropathy (DN), remains a leading cause of chronic kidney disease and death worldwide. In Nigeria, the burden of DN is worsened by poor healthcare access, late diagnosis, and limited use of modern diagnostic tools, leaving many cases undetected until advanced stages.

Aims: To assess the biochemical markers for early detection of diabetic nephropathy (DN) among newly diagnosed diabetes mellitus (DM) patients in Ogbomoso, Nigeria.

Study Design: A cross-sectional study design was employed, with data collected from 133 participants (78 diabetic, 36 prediabetics and 19 non-diabetic participants) from both urban and rural areas in Ogbomoso. Biochemical tests were conducted to measure fasting blood glucose (FBG), serum creatinine, cystatin C, and urinary microalbumin levels. Additionally, sociodemographic data were gathered through structured questionnaires, and anthropometric measures like BMI and waist circumference were taken. The study used standard diagnostic criteria to classify the participants and evaluate renal function.

Results: Fasting blood glucose (FBG) differed significantly across groups (F = 95.37, p < 0.001), with diabetics showing markedly higher levels. In contrast, renal biomarkers urea (p = 0.618), creatinine (p = 0.972), cystatin C (p = 0.451), microalbuminuria (p = 0.247), and urine glucose (p = 0.142) exhibited no significant inter-group differences, indicating no variation in kidney function markers despite elevated glucose in diabetics. Among newly diagnosed diabetic patients, 39.7% displayed at least one abnormal diabetic nephropathy (DN) marker. Cystatin C emerged as the most accurate early detection biomarker, with 88.2% sensitivity, outperforming microalbuminuria and creatinine. Anthropometric measures, including BMI and waist circumference, were significantly linked to DN risk.

Conclusion: The study advocates integrating cystatin C into routine DN screening for newly diagnosed diabetics to enable early intervention and halt progression to severe kidney damage.

Sepsis-induced Acute Kidney Injury in Women Undergoing Pelvic and Abdominal Surgery

Juan Gustavo Vázquez-Rodríguez, Juan Gustavo Vázquez-Arredondo — Fri, 16 Jan 2026 00:00:00 +0000

Background: Reports of morbidity and mortality from surgical sepsis-induced acute kidney injury (AKI) in women are scarce.

Aims: Determine the incidence, clinical course, management, and outcome of sepsis-induced AKI in women undergoing pelvic and abdominal surgery.

Study Design: Observational, longitudinal, retrospective, descriptive, and analytical study.

Place and Duration of Study: Intensive Care Unit (ICU) of the High Specialty Medical Unit, Gynecology and Obstetrics Hospital No. 3 of National Medical Center “La Raza” belonging to the Mexican Institute of Social Security, Mexico City between January 1, 2023, to December 31, 2024.

Methodology: A retrospective cohort of 31 women with surgical sepsis admitted to the ICU was studied. The records were consulted to obtain general data and clinical characteristics of sepsis. The frequency of AKI was determined at three times: admission, stay in ICU and at discharge. It was not possible to determine serum creatinine values or uresis ml/K/hour before admission to the ICU. Therefore, a serum creatinine concentration ≥1.1 mg/dL at ICU admission was considered representative of AKI (baseline data). To define AKI during the stay and discharge from the ICU, the criteria and classification of the Clinical Practice Guideline for AKI issued by Kidney Disease Improving Global Guidelines (KDIGO) in 2012 were considered. The incidence, clinical course, management, and outcome of surgical sepsis-induced AKI (hemodialysis, mortality) were studied.

Results: Age 48.22±15.14 years. Sepsis associated with cancer surgery 48.39% (n=15), internal genital organ surgery 29.03% (n=9) and surgery during pregnancy or postpartum 22.58% (n=7). Infectious focus: internal genital organs 87.10% (n=27), large intestine 9.68% (n=3) and lungs 3.22% (n=1). Positive cultures 48.39% (n=15) with predominance of E. coli.

Incidence of AKI in the ICU: admission 51.61% (n=16, creatinine 1.35±1.65 mg/dL), ICU stay 35.48% (n=11, creatinine 2.32±2.27 mg/dL) and discharge of ICU 25.80% (n=8, creatinine 1.8±0.57 mg/dL). Hemodialysis was performed in 31.25% (n=5/16). Stay in the ICU: without AKI 4.69±2.20 days and with AKI 7.75±1.34 days (P=.016). Mortality was 9.68% (n=3).

Conclusion: The incidence of surgical sepsis-induced AKI was found to be very high. The main characteristic was the recovery of renal function, but the complication did not resolve in all cases. A considerable percentage of patients required hemodialysis after discharge from the ICU. AKI increased the length of stay in the ICU, but not overall mortality.

Assessment of Medication Therapy Management in Patients on Haemodialysis at the Yaoundé University Teaching Hospital, Cameroon

Tue, 27 Jan 2026 00:00:00 +0000

Introduction: Clinical pharmacy is a branch of pharmacy that is patient centred. It was born in the Western world and is well established in countries like USA, Canada, United Kingdom and France. In Cameroon, it was recently (2022) introduced in the medical training programme as a specialization in pharmacy. Its objectives include but are not limited to; the safe, effective and rational use of health products. Healthcare providers may prioritize which hospital services may require clinical pharmacists according to medical needs, budget and other constrains. Effective medication therapy management may result in reduced risk of drug interactions, adverse drug events and optimisation of drug therapy leading to lower health care costs. The organ which is most involved in the excretion of drugs and/or metabolites from the body is the kidney and patients with impaired kidney may be at risk of adverse drug reactions and drug interactions. Therefore, the haemodialysis unit was chosen to conduct this study to investigate medication therapy management in patients with end stage renal kidney disease at the Yaoundé University Teaching Hospital.

Material and Methods: A cross-sectional study was carried out in the haemodialysis unit at the Yaoundé University Teaching Hospital for a period of 8 months from October 2023 to May 2024. The study populations were patients with end-stage renal disease on haemodialysis and medical personnel following these patients. The study tools were questionnaires addressed to patients and medical personnel as well as data collection sheets. Administrative and research authorisations were obtained. Data collected were medical personnel’s knowledge and attitude towards medication therapy management, number of drugs prescribed per patient, therapeutic classes of drugs prescribed, patient medication-taking behaviour, non-prescription drugs and herbal remedies use. Data were analysed using the software Epi info 7.2.5.0 and interpreted as either low, medium or high risk of adverse drug reaction and/or drug interaction. Data were reported as frequencies (n) and percentages (%) and displayed using tables and figures.

Results: 2 clinicians were recruited as those being involved in the drug therapy of patients; and 100 patients were recruited with a clinician to patient ratio of 2:100. One out of two clinicians had basic knowledge of medication therapy management and both had an unsatisfactory attitude towards medication therapy management.

Risk of drug interaction was medium to high; 76% of patients were prescribed between 4-12 medications, 63% buy their medications from multiple pharmacies, 16% consume herbal medicines and 17% non-prescribed drugs. The risk of adverse drug reaction was low to medium. 23% of patients experienced hypotension, 33% were not taking their medications as prescribed and 54% were not reviewed for their medications routinely.

Conclusion: This study showed that clinicians in the haemodialysis unit have basic knowledge of medication therapy management but are resistant to the input of another healthcare professional, without realising that this aspect of care falls within the clinical pharmacy services. Patients on haemodialysis with end stage renal disease have poor medication-taking habits, consume herbal medicines and non-prescription drugs which exposes them to medium to high risk of drug interactions and low to medium risk of adverse drug reactions. These risks can be further lowered by the counselling and management of the medications of these patients by a clinical pharmacist.

Waterpipe Tobacco Smoke–induced Renal and Hepatic Toxicity and Associated Heavy Metal and Polycyclic Aromatic Hydrocarbon Levels in Female Albino Rats

Nwaokezi, Christian Obi, Jamabo, Miebaka, Amechi, Prince Aruchi, Osademe, Dollar — Mon, 16 Feb 2026 00:00:00 +0000

The widespread use of water pipe tobacco (WPT) has raised concerns regarding potential health risks associated with inhalation of tobacco smoke and its constituents, including polycyclic aromatic Hydrocarbons (PAHs). This study evaluated the effect of water pipe tobacco smoke on renal and hepatic biomarkers in blood serum of female albino rats. Fifteen (15) female albino rats weighing between 100g to 150g were used for the experiment and randomized into three groups of five animals each. Group 1 served as the control which was animals not exposed to water pipe tobacco (shisha) smoke, while group 2 and 3 were animals exposed to water pipe tobacco smoke at the duration of 30 seconds and 50 seconds per cycle for 15 minutes respectively for a period of 13 days. All exposures of the animals to the water pipe tobacco smoke were conducted in an enclosed improvised glass inhalation chamber coupled to a vacuum pump and water pipe tobacco (shisha) pot to generate the smoke. Blood serum samples collected were subjected to various biochemical assays to determine renal and hepatic biomarkers, heavy metals including PAHs. Results revealed gradual to significant dose-dependent alterations in both hepatic and renal biomarkers in the shisha-exposed groups accompanied by evident electrolyte imbalance. Oxidative stress markers showed a decreased superoxide dismutase activity and increased malondialdehyde levels in the exposed groups. Elevated concentrations of heavy metals were observed and several components of PAHs detected at varying concentrations. Generally, these findings indicate that the exposure to water pipe tobacco smoke adversely affects renal and hepatic functions and poses a significant health risk. The observed alteration in the hepatic and renal biomarkers together with accumulation of heavy metals and PAHs may be attributed to the toxic mixture of constituents present in the water pipe tobacco smoke.

The Tie-In Between Antimicrobial Agent (Nitrofurantoin) and Kidney Histology Using an Animal Model

Goodluck Silas, Marcus O. Ifeh, Williams Azibagir — Tue, 31 Mar 2026 00:00:00 +0000

This study investigates the histological effects of nitrofurantoin, a widely used nitrofuran-class antibiotic for treating urinary tract infections (UTIs), on the kidneys of male albino rats. Nitrofurantoin, effective against Gram-positive and Gram-negative bacteria, is excreted primarily through the kidneys, raising concerns about potential nephrotoxicity. Despite its clinical utility, limited research exists on its renal impact, particularly at the histological level. This research reveals the effect of Nitrofurantoin on the kidney histology and weight of an albino rat. The research was carried out within a total period of 3 months. This experimental study utilized 20 male albino rats weighting between 129-152g divided into four groups: a control group receiving distilled water and three test groups administered 25%, 50%, and 75% of the lethal dose 50 (LD50) of nitrofurantoin (151 mg/kg, 302 mg/kg, and 453 mg/kg, respectively) orally for 21 days which is the number of days drugs were administer. Before the 21 days, the animals were allowed to acclimatize to the environment for 7 days. Post-treatment, the kidneys were excised, fixed in 10% formal saline, and processed using Haematoxylin and Eosin (H&E) staining for histological analysis. The total Results revealed significant weight loss in treated rats (p = 0.009) compared to controls (p = 0.335), indicating systemic effects potentially linked to renal or metabolic stress. Histological examination showed normal renal architecture in the control group, while treated groups exhibited dose-dependent changes, including mild glomerular necrosis, tubular damage, and focal fibrosis, suggestive of oxidative stress and inflammatory responses. These findings confirm that nitrofurantoin induces renal tissue damage, with severity increasing with dosage, emphasizing the need for cautious dosing and renal function monitoring during therapy. The study highlights the importance of pre-treatment renal screening to identify at-risk patients and recommends further research to establish safe dosage guidelines and explore protective interventions against nitrofurantoin-induced nephrotoxicity. These insights contribute to improved therapeutic protocols, ensuring patient safety and optimizing the clinical use of nitrofurantoin in managing UTIs.

Evaluation of Renal Function Indicators and Systemic Electrolytes in End-stage Renal Disease Patients Undergoing Maintenfance Hemodialysis in Diwaniyah Governorate, Iraq

Haneen Falah Abbas, Zahraa Abdul Sahib Abdul Amir, Zahraa Bashar Karim — Sat, 04 Apr 2026 00:00:00 +0000

Background: Chronic kidney disease frequently progresses to end-stage renal disease, necessitating hemodialysis. This life-saving therapy alters the metabolic environment, making the continuous monitoring of biochemical parameters vital. Objective: This study aimed to evaluate renal function indicators and systemic electrolytes among end-stage renal disease patients undergoing regular hemodialysis in Diwaniyah Governorate.

Methods: A cross-sectional analytical study included 90 adults: an experimental group of 70 patients receiving maintenance hemodialysis and a control group of 20 healthy subjects. Venous blood samples were collected prior to dialysis sessions and analyzed for blood urea, serum creatinine, uric acid, and electrolytes.

Results: Renal function indicators were significantly elevated in the patient cohort; mean serum creatinine and blood urea surged to 8.4 ± 1.8 mg/dL and 145.6 ± 22.4 mg/dL, respectively, compared to controls (P ≤ 0.001). Furthermore, severe systemic electrolyte imbalances were detected, characterized by significant hyperkalemia (5.6 ± 0.6 mEq/L) and hyperphosphatemia (6.3 ± 1.2 mg/dL), alongside marked hypocalcemia (7.8 ± 0.7 mg/dL) (P ≤ 0.001). Sodium levels remained statistically comparable between the two groups. Conclusion: Routine hemodialysis partially fails to restore physiological equilibrium, leaving patients highly susceptible to severe uremia and electrolytic derangements. The strict implementation of tailored dietary counseling and optimized dialysis prescriptions is urgently recommended to improve patient outcomes.

Serum Uric Acid and Uric Acid Creatinine Ratio as Emerging Indicators of Renal Adaptation and Risk in Pregnancy

Tarila Ngowari Aleruchi-Didia, Ojoye Ngoye Briggs, Kemzi Nosike Elechi-Amadi — Mon, 04 May 2026 00:00:00 +0000

Background: Serum uric acid has emerged as a clinically relevant biomarker in pregnancy due to its association with renal function, oxidative stress, and hypertensive disorders such as preeclampsia. The uric acid–creatinine ratio has been proposed as a more sensitive indicator of renal adaptation, as it accounts for variations in glomerular filtration.

Objective: This study evaluated serum uric acid levels and the uric acid–creatinine ratio as indicators of renal adaptation among pregnant women in Port Harcourt, Nigeria, and compared findings with non-pregnant controls.

Methods: A cross-sectional analytical study was conducted among 150 women, comprising 90 pregnant women (30 per trimester) and 60 non-pregnant controls. Blood samples were collected and analyzed for creatinine, urea, electrolytes, and uric acid using standard laboratory methods. The uric acid–creatinine ratio was calculated. Data were analyzed using SPSS version 24, with statistical significance set at p < 0.05.

Results: Pregnant women had significantly higher levels of creatinine, urea, potassium, chloride, bicarbonate, uric acid, and uric acid–creatinine ratio compared to non-pregnant controls (p < 0.05), while sodium levels showed no significant difference. Across trimesters, creatinine increased significantly (p = 0.026), and chloride decreased in the third trimester (p = 0.043). Uric acid levels and derived ratios did not vary significantly across trimesters. Age-related analysis showed a significant decline in potassium levels with increasing age (p = 0.032).

Conclusion: Serum uric acid and the uric acid–creatinine ratio are elevated in pregnancy and reflect important renal adaptations. These biomarkers may serve as useful, cost-effective tools for monitoring renal function and identifying early risk of pregnancy-related complications.

Evaluation and Patterns of Vascular Access among Chronic Kidney Disease Patients on Maintenance Haemodialysis in a Tertiary Hospital in Nigeria: A Retrospective Descriptive Study

Henry Ohem Okpa, Bemigho Ayo Odonmeta — Sat, 30 May 2026 00:00:00 +0000

Introduction: Haemodialysis vascular access is pivotal as it impacts on the quality of care of chronic kidney disease patients, and guidelines recommend arteriovenous fistula (AVF) as the preferred access route for better outcomes. However, in resource-limited settings, there are challenges associated with creation of AVF, leading to heavy reliance in the use of central venous catheters (CVCs) for haemodialysis.

Aim: The main objective of this study is to determine the patterns of vascular access among chronic kidney disease (CKD) patients on maintenance haemodialysis (HD).

Methods: A hospital-based retrospective, descriptive study was conducted among 544 CKD patients on maintenance HD at the dialysis centre of the University of BeninTeaching Hospital (UBTH). Data was manually collected from the medical records of patients who received HD treatment over a period of 3 years. Data were analyzed using descriptive statistics, and presented as tables and charts.

Results: Among the CKD patients, there were more males (59.3%) as compared to females (40.7%), and the mean age of the study population was 43.1±16.8 years. There was a high prevalent use of central venous catheters (97.0%) for HD, and femoral catheters (95.6%) were most commonly used compared to the other catheters. Only a very small proportion used AVF (3.0%), however, there was an increasing trend in the use of AVF from 18.8% to 81.2% and a decreasing trend in CVCs use from 37.5% to 29.5%. Chronic glomerulonephritis (40.9%) was the commonest cause of CKD that necessitated the initiation of HD.

Conclusion: Our study highlighted the prevalent use of central venous catheters as the primary vascular access method for CKD patients on maintenance hemodialysis. These findings underscore the urgent need to improve access to AVF and enhance vascular access management, ultimately optimizing patient outcomes in resource-limited settings.

Pharmacotherapy for Hypertension in Chronic Kidney Disease: An Overview

Akhila Gundeti, Haritha Pasupulati, Satyanarayana S. V. Padi — Mon, 01 Jun 2026 00:00:00 +0000

Chronic kidney disease (CKD) is one of the leading causes of death. It is characterized by progressive decline in glomerular filtration rate (GFR), irreversible structural and functional kidney damage often associated with co-morbidities and multiple complications, including hypertension, diabetes, and cardiovascular diseases. The stages of CKD are classified based on GFR and albuminuria levels, and early detection is important for slowing progression and managing complications. Hypertension (HTN) is one of the leading causes and comorbidities and an independent modifiable risk factor in CKD, and unmanaged HTN progresses to decline in kidney function and kidney damage, resulting in advanced CKD (4 or 5 stage) and end-stage renal disease (ESRD). Both pharmacological and non-pharmacological approaches are involved in the management of HTN in CKD. The review focuses on pharmacotherapy for HTN in CKD patients, with special emphasis on the individualization of therapy based on kidney function, disease stage, and blood pressure status. According to the latest clinical practice guidelines, HTN is preferably treated with RAAS inhibitors (ACEIs or ARBs) alone or in combination with diuretics and/or calcium channel blockers; to some extent, add-on beta-blockers or centrally acting agents are also recommended. Newly recommended treatment strategies include using drugs that provide additional cardiorenal protection and slow kidney damage. Additionally, evidence-based and clinically proven advancements in the management of HTN in CKD are discussed.