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Abstract: PO1789

Higher Plasma Renin Activity Level Is Associated with the Severe Intrarenal Arterial Injury in Patients with Hypertensive Emergency

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials


  • Ushimaru, Shu, Sei Marianna Ika Daigaku Byoin, Kawasaki, Kanagawa, Japan
  • Shirai, Sayuri, Sei Marianna Ika Daigaku Byoin, Kawasaki, Kanagawa, Japan
  • Sakurada, Tsutomu, Sei Marianna Ika Daigaku Byoin, Kawasaki, Kanagawa, Japan
  • Shibagaki, Yugo, Sei Marianna Ika Daigaku Byoin, Kawasaki, Kanagawa, Japan
  • Ichikawa, Daisuke, Sei Marianna Ika Daigaku Byoin, Kawasaki, Kanagawa, Japan

It is well known that most patients with hypertensive emergencies have high plasma renin activity (PRA) levels, which indicates the pathophysiology of organ damage. However, the association with intrarenal arterial injury and PRA level has not been well documented.


We herein investigated this association retrospectively in patients who were diagnosed with hypertensive emergency and were also evaluated the PRA and underwent kidney biopsy between April 2001 and September 2019. The severity of intrarenal arterial injury was classified into stage 0 to stage 3 based on the report by Kohagura et al (Hypertens Res. 2013).


A total of 13 patients (mean age; 39.2±11.2 years, male; 92.3%, BMI; 26.4±3.9 kg/m2, history of hypertension; 92.3%) were included in this study. All patients had higher systolic blood pressure (≧180 mmHg), and 12 patients had higher diastolic pressure (≧120 mmHg). At admission, 12 patients had kidney injuries, 12 patients had hypertensive retinopathy, 6 patients had acute heart failure, and 1 patient had lacunar infarction. The average PRA levels at admission was 20.0±2.8 ng/mL/ hr. The average duration from diagnosis to kidney biopsy were 14.4 days. The median eGFR on the day of kidney biopsy was 15.3 [IQR 9.1, 21.7] mL/min/1.73m2. PRA was significantly and positively correlated with severity of intimal edema of intrarenal small arteries (r2=0.42, p=0.02). However, no association was found between PRA and other histological kidney injury.


Since vascular injury directly leads to organ damage, its presence calls for urgent need for blood pressure lowering with caution for ischemia. Since biopsy is often not available, PRA can be a good substitute to assess vascular injury in the management of those with acute severe hypertension.