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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. 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