Pediatric Renal

Question 1

define normal BP for chidlren 1-13

Answer 1

normal bp <90th percentile -

for children older than 13 – <120/<80 mmHg

Question 2

define stage 1 HTN in children 1-13

Answer 2

greater than or equal to 95th percentile +12mmHg or 130/80 to 139/89, whichever is lower

Question 3

define stage 2 HTN in children 1-13

Answer 3

greater than or equal to 95th percentile + 12mmHg or greater than 140/90, whichever is lower

Question 4

T/F the popiteal Systolic BP is lower than brachial arterial pressure

Answer 4

false - leg pressure is higher by 10-20%

Question 5

at what age is it recommended to begin BP testing

Answer 5

begin BP measurement at age 3

annual measurement is recommended unless risk factors are present

Question 6

what risk factors, if present, would lead one to check BP at every health care encounter in children older than 3

Answer 6

obesity
taking medication known to increase BP 
have renal disease 
history of aortic arch obstruction or coarctation 
diabetes

Question 7

conditions under whihc children younger than 3 should bhave BP measured

Answer 7

history of prematurity
known renal disease

others - congenital heart dz, recurrent UTI, hematuria or proteinuria, family hx of congenital renal dz, solid-organ transplant, malignancy or bone marrow transplant, tx with drugsk nown to raise BP, other systemic illnesses associated with HTN, evidence of elevated intracranial pressure

Question 8

in order to classify a child as hypertensive, how many separate BP must be obtained

Answer 8

3 measurements greater than 90th percentile
at first measurement over 90th, remeasure and average, if still above 90th percentile, remeasure by ausculatory technique and if its still 90th, classify BP according to guidelines
might be 95th percentile

Question 9

how to manage elevated office blood pressure if its still elevated after 6 months

Answer 9

check upper and lower extremity BP

recheck bp in 6 months by auscultation

Question 10

how to manage elevated office blood pressure if its still elevated after 12 months

Answer 10

(3 time points)
ABPM
diagnostic eval
consider subspecialty referral

Question 11

if patient is symptomatic or BP is >30mmHg above 95th percentile, what action should be taken

Answer 11

refer for emergency care