Hypertension in children

Question 1

Give the definiton of hypertension in children

Answer 1

HTN in peds is blood pressure > 95th percentile for gender/height

Question 2

Just flip this card and read about some important information regarding pediatric hypertension.

Answer 2

■ HTN is 3rd most common chronic disease in children.
■ HTN should be suspicious for aortic coarctation, should check lower extremities too. Kidney and GI are sensitive to hypoxia, causing necrotizing enterocolitis, oliguria.
■ Teenagers often have essential HTN.
■ Premature babies are more likely to develop HTN later on.

Question 3

Give the Renal and Extrarenal causes of Pediatric Hypertension.

Answer 3

Renal causes:
(Kidney disease is most frequent cause of HTN before adolescence)
Glomerulonephritis (IgA nephropathy/HSP, PSGN).
Chronic pyelonephritis.
Reflux nephropathy.
Congenital/structural kidney defects.

Extrarenal causes:
Coarctation of aorta (Leds to increased resistance, collateral circulation, and RAAS activation).
Renal artery thrombosis/stenosis.
Endocrine pathology (thyroid, adrenal, Cushing).

Question 4

(Bonus) How to diagnose coartication of aorta and how can someone survive until adolescence?

Answer 4

○ Diagnosis :BP measurment of upper and lower limbs ( difference more than 10 mmHG)

○Survival is achieved by forming collaterals between IMA and Aorta.