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How can kidney disease cause secondary hypertension?

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The role of coronary artery disease in heart attack — cardiovascular disease This micrograph shows a cross section of a coronary artery narrowed by an atherosclerotic plaque (purplish matter inside the artery). Most heart attacks are caused by the rupture of an atherosclerotic plaque, which triggers the formation of a clot that abruptly blocks blood flow to part of the heart muscle.

Kidney disease can cause secondary hypertension primarily through the activation of the renin-angiotensin system, a physiological mechanism that regulates blood pressure.1

When renal disease—such as renal artery stenosis—causes a reduction in blood flow to the kidneys, the juxtaglomerular apparatus (JGA) detects this decrease and increases the secretion of the enzyme renin. Renin triggers a cascade that leads to the formation of angiotensin II, a potent substance that raises blood pressure by constricting small arteries (arterioles) and stimulating the adrenal glands to release aldosterone. Aldosterone promotes the retention of salt and water by the kidneys, further increasing blood volume and pressure.4123

Additionally, in chronic kidney disease, the progressive loss of nephrons impairs the kidneys' ability to regulate fluid and electrolyte balance. The resulting inability to adequately excrete sodium and water contributes to fluid retention and elevated blood pressure, creating a cycle where hypertension causes further damage to the renal structures.456