High altitude renal syndrome: four elements or one source?

Area of Science:

• High Altitude Physiology
• Nephrology
• Hematology

Background:

• High Altitude Renal Syndrome (HARS) presents with polycythemia, hyperuricemia, hypertension, and albuminuria.
• Hypoxia-induced High Altitude Polycythemia (HAPC) is identified as the central etiological factor in HARS.
• Established diagnostic criteria for HAPC exist, defined by elevated hemoglobin levels at high altitudes.

Purpose of the Study:

• To review the pathophysiology of HARS, focusing on HAPC as the primary driver.
• To discuss current and emerging treatment strategies for HAPC and its renal manifestations.
• To advocate for revised diagnostic criteria and treatment prioritization for HARS.

Main Methods:

• Literature review of studies on HARS and HAPC.
• Analysis of pathological mechanisms, including HIF-2α involvement in glomerular damage.
• Evaluation of therapeutic interventions for HAPC and associated symptoms.

Main Results:

• HAPC leads to systemic hypoxia, hyperuricemia, hypertension, and glomerular injury.
• Pathological mechanisms involve HIF-2α-mediated glomerular hypertrophy and podocyte damage.
• Various treatments exist, including carbonic anhydrase inhibitors, antihypertensives, urate-lowering drugs, and experimental therapies.

Conclusions:

• HAPC is the principal cause of HARS.
• Current treatment strategies address HAPC and its downstream effects.
• Revised diagnostic criteria and treatment prioritization are recommended for HARS.