Pediatric Hypertension Flashcards
What defines a normal blood pressure in kids?
Less than the 90th percentile for that child’s height percentile and age
What defines stage 1 HTN in children?
Greater or equal to 95th percentile to < 95th percentile + 12 mmHg
What defines Stage 2 HTN in children?
Greater than or equal to 95th percentile + 12 mmHg
Should BP be higher in the arms or legs and what are consequences if this is not true?
BP should be 10 - 20 mmHg higher in the legs
If not be concerned of coarctation of the aorta
How many times do you have to record HTN in a patient before it can be confirmed that the patient indeed has HTN?
3 times during 3 separate visits
Primary HTN is the predominant cause of HTN in US children. Describe the characteristics of primary HTN
- Greater than or equal to 6 years of age
- family hx of HTN
- obesity or overweight
“Is his BP ok??” What’s the rule of thumb for children 1 - 10 years of age for determining the lower limit of BP?
must be < 70 + (age x 2)
Describe White-Coat HTN
Patient presents with a BP > 95th percentile, but is actually normotensive outside the clinical setting
Try to obtain these patients BP outside the clinical setting (ex. Take at home, take at walgreens)
What is Masked HTN?
Opposite of White-Coat HTN
patient w/ BP > 95th percentile outside a clinical setting, but normotensive in the clinical setting
At what point are Karotkoff sounds absent?
During Diastole
This should be the point at which the swooshing of blood should no longer be heard but if present all the way to zero we call it the “4th Karotkoff sound”
In older, school age children, prevalence of primary hypertension has increased hand-in-hand with the _______ __________
Obesity epidemic
What is the most definitive way of determining that a patients BP has been high for an extended period of time leading to left ventricular hypertrophy
echocardiogram
Define hematuria
Prescence of 3 - 5 RBCs per high power field in 3 consecutive fresh specimens over span of a few weeks
What foods might color the urine?
- Beets
- Rhubarb
- Fruit juices
What drugs might color the urine?
- Rifampin
- Nitrofurantoin
- Pyridium
- Sulfa drugs
Why might a newborns diaper appear bloody in color?
due to uric acid crystals in the urine of a newborn (brick red color)
Newborn requires only hydration
If you want to determine that blood seen in urine is from RBCs what must you order?
UA w/ microscopy
Distinguish glomerular from extra-glomerular hematuria
Glomerular:
- dysmorphic RBCs
Extra-glomerular:
- More normal appearing RBCs and intact
Hematuria is not as ominous as hematuria and ________ put together
Proteinuria
Lupus
Think glomerulonephritis
most specifically: mesangial proliferative lupus nephritis (class II)
Henoch - Schonlein Purpura
- Immune complex vasculitis (IgA)
- purpura everywhere (buttocks, lower legs, elbows)
- follows a viral infection
- Will have gross hematuria
- can have proteinuria also —> will progress to end stage renal disease
In HSP the development of _________ along with hematuria is prognostically indicative of potential long term _______ _________
Proteinuria; renal damage
Occurs in males only, dilation of the bladder, ureters, and kidneys
Posterior Urethral Valves (PUV)
What is the best way of obtaining a specimen from a child?
Catheterization
suprapubic aspiration
Bag urine only helpful if negative
