Su YJ. Renal diseases and blood pressure dysregulation in acute care: Pathophysiology, clinical patterns. World J Nephrol 2026; 15(3): 121561 [DOI: 10.5527/wjn.121561]
Corresponding Author of This Article
Yu-Jang Su, MD, Associate Professor, Division of Toxicology, Department of Emergency Medicine, MacKay Memorial Hospital, No. 92 Section 2, Chung-Shan N Road, Taipei 10449, Taiwan. pioneermd1@gmail.com
Research Domain of This Article
Emergency Medicine
Article-Type of This Article
review-article
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Nephrol. Sep 25, 2026; 15(3): 121561 Published online Sep 25, 2026. doi: 10.5527/wjn.121561
Renal diseases and blood pressure dysregulation in acute care: Pathophysiology, clinical patterns
Yu-Jang Su
Yu-Jang Su, Division of Toxicology, Department of Emergency Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan
Yu-Jang Su, Department of Nursing, Yuanpei University of Medical Technology, Hsinchu 300, Taiwan
Yu-Jang Su, School of Medicine, College of Medicine, Mackay Medical University, New Taipei City 252005, Taiwan
Yu-Jang Su, Department of Nursing, MacKay Junior College of Medicine, Nursing and Management, New Taipei 252, Taiwan
Author contributions: Su YJ was responsible for program investigator, writing draft, revision, and corresponding.
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Conflict-of-interest statement: The author declares no conflict of interest in publishing the manuscript.
Corresponding author: Yu-Jang Su, MD, Associate Professor, Division of Toxicology, Department of Emergency Medicine, MacKay Memorial Hospital, No. 92 Section 2, Chung-Shan N Road, Taipei 10449, Taiwan. pioneermd1@gmail.com
Received: March 27, 2026 Revised: April 22, 2026 Accepted: June 11, 2026 Published online: September 25, 2026 Processing time: 139 Days and 10.6 Hours
Abstract
Blood pressure (BP) abnormalities are clues to make differential diagnosis and prognostic indicators in various renal diseases in the emergency department (ED), arising from and contributing to kidney dysfunction via activation of the renin-angiotensin-aldosterone system, impaired perfusion, volume overload in chronic kidney disease (CKD) patients, inflammatory processes, and traumatic structural injury. This narrative review summarizes BP patterns and pathophysiology across common renal conditions in the ED, including acute kidney injury, CKD, end-stage renal disease, glomerulonephritis, renal trauma, pyelonephritis, renal artery stenosis, nephrolithiasis, renal infarction, and renal tubular acidosis. Distinct BP profiles are observed: Hypotension often indicates prerenal, septic, or shock-associated acute kidney injury, severe infection, trauma, or shock, while hypertension predominates in CKD, end-stage renal disease, and ischemic or obstructive conditions due to renin-angiotensin-aldosterone system activation and sodium retention. Some disorders show variable BP patterns depending on stages, severity, and comorbidities. Overall, BP abnormalities provide valuable diagnostic and management guidance. Recognizing these predictable hemodynamic responses supports timely diagnosis, risk stratification, and targeted ED management.
Core Tip: Blood pressure abnormalities in renal diseases present distinct yet mechanistically predictable patterns in the emergency department. Hypotension often reflects hypoperfusion, sepsis, or trauma, while hypertension is commonly driven by renin-angiotensin-aldosterone system activation, volume overload, or renal ischemia. Recognizing these characteristic hemodynamic profiles enables rapid diagnosis, risk stratification, and targeted management. Integrating blood pressure patterns with clinical context provides a practical and efficient framework for evaluating various renal conditions in acute care settings.
