38. Childhood systemic hypertension.

Question 1

Hypertension

Definition

Classification

Answer 1

Blood pressure above 95th Percentile for age, gender and height

• Primary
  
  • Essential
  • Metabolic Syndrome
• Secondary
  
  • Renal
  • Endocrine
  • Neurological
  • Vascular

Question 2

Hypertension

Renal causes

Answer 2

• Congenital anomalies
  
  • Renal dysplasia
  • Obstructive uropathy
• Structural disorders
  
  • Wilms tumor
  • Polycystic kidney disease
  • Glomerulonephritis
• Acquired injury
  
  • Renal scarring
  • Acute tubular necrosis

Question 3

Hypertension

Endocrine causes

Answer 3

• Catecholamine-secreting tumors
  
  • Pheochromocytoma
  • Neuroblastoma
• Hypercortisolism
  
  • Cushing syndrome
• Hyperaldosteronism
• Hyperthyroidism

Question 4

Hypertension

Neurological Causes

Answer 4

• Increased sympathetic activity
  
  • Stress
  • Anxiety
  • Pain
• Dysatonomia
• Increased ICP

Question 5

Hypertension

Vascular Causes

Answer 5

1. Coarctation of the aorta
2. Renal artery embolism
3. Renal vein thrombosis
4. Renal artery stenosis
5. Vasculitis

Question 6

Hypertension

Clinical Manifestations

Answer 6

• mosly asymptomatic
• associated Signs and Symptoms:
  
  • encephalopathy
    
    • headache vomiting, sizures
  • heart failure
  • stroke
  • retinopathy
    
    • blurred vision, flame hemorrhage, cotton wood spots on retina

Question 7

Important Clinical Findings in Certain Causes of Hypertension

Answer 7

• abdominal bruit
• weak femoral pulse ► coarctation of the aorta
• café au lait spots ► neurofibromatosis
• flank mass ► hydronephrosis
• tachycardia with flushing and diaphoresis ► phenochromocytoma
• truncal boesity, acne, striae, buffallo hump ► cushing
• signs of underlying kidney disease

Question 8

Hypertension

Diagnostic Studies

Answer 8

1. Baseline ecological assessment
   
   • urineanalysis, electrolytes, blood urea nitrogen, creatinine, renal US
2. Focussed studies based on clinical suspicion
   
   • plasma metanephrines, thyroid studies, vascular imaging
3. Assessment for target organ damage
   
   • ECG
4. Assessment of other CVS risk factors
   
   • lipids, fasting glucose, uric acid

Question 9

Hypertension
Treatment

Answer 9

• Stage 1 HTN without organ changes:
  
  • Therapeutic lifestyle changes (diet, exercise)
• Stage 2
  
  • Medication:
    
    • CCBs, ACEis, beta-blockers, diuretics
• Emergency Hospitalization
  
  • parenteral antihypertensive treatment
    
    • nicarpine
    • labetalol
    • esmolol
    • sodium nitroprusside