Table 2.

Paradigm of acute changes in kidney function that may be hemodynamic and reversible vs potentially irreversible

	Hemodynamic and Reversible	Potentially Irreversible
Physiology	Decrease in intraglomerular pressure without ischemia or tubular injury	Decrease in intraglomerular pressure with ischemia and possible tubular injury
Pathology	No change	Possible tubular injury and tubulointerstitial fibrosis
Outcomes	May decrease risk for progression of kidney disease	Increase risk for progression of kidney disease
Predisposing factors	Intensive BP control, ACEI/ARB or SGLT-2 inhibitor use, HFrEF	Intensive BP control, ACEI/ARB or SGLT-2 inhibitor use, HFrEF in the setting of an individual with altered autoregulation (e.g. elderly, advanced CKD, diabetes) and volume depletion
Preventative measures	Unclear need for preventative measures; potential slower up-titration of anti-hypertensive agents	• Avoid hypovolemic states  • Hold anti-hypertensive medications in the setting of acute illnesses such as diarrhea  • Avoid concomitant use of nephrotoxic agents during intensive BP therapy

Abbreviations: BP, blood pressure; CV, cardiovascular; ACEI/ARB, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker; SGLT-2, sodium glucose co-transporter 2, HFrEF, heart failure reduced ejection fraction; CKD, chronic kidney disease