Renal hypertension is one of the earliest and the most prevalent
complications of pediatric chronic kidney disease (CKD). Among renal
patients, hypertension is frequently underdiagnosed and undertreated. For
casual blood pressure measurement, the best method is auscultatory, while for
ambulatory blood pressure measurement, oscillometric method is the most
commonly used. Both casual and ambulatory blood pressure measurement provide
more powerful means of diagnosing hypertension. Masked hypertension is a
condition in which casual blood pressure is normal but ambulatory blood
pressure is elevated. The risk of cardiovascular morbidity and mortality is
higher with masked hypertension as compared to the controls. Children and
adolescents with CKD are at high risk of cardiovascular disease that has been
established as the leading cause of death in patients with end stage renal
disease. Left ventricular hypertrophy remains the most thoroughly documented
form of end-organ damage caused by hypertension in children and adolescents
with CKD. Based on clear evidence on the correlation between blood pressure
and cardiovascular morbidity, mortality, and renal function, renal
hypertension must be aggressively treated. Target blood pressure for patients
with renal hypertension should be at low normal values: <75 percentile for
patients without proteinuria and <50 percentile for patients with
proteinuria. Renin-angiotensin system antagonists are considered the first
choice pharmacological option in hypertensive CKD 2-4 patients while the
management of volume overload is the most important in dialysis patients.
Successful transplantation can eliminate or significantly improve
uremia-related cardiovascular risk factors and increase predicted life
expectancy.
Renal hypertension and cardiovascular disorder in children with chronic kidney disease
