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Hypertension in pediatric patients with chronic kidney disease: management challenges

Authors Gallibois CM, Jawa NA, Noone DG

Received 22 May 2017

Accepted for publication 22 June 2017

Published 26 July 2017 Volume 2017:10 Pages 205—213


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Professor Pravin Singhal

Claire M Gallibois,1,2 Natasha A Jawa,1 Damien G Noone1

1Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada; 2Faculty of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland

Abstract: In contrast to adults where hypertension is a leading cause of chronic kidney disease, in pediatrics, hypertension is predominantly a sequela, however, an important one that, like in adults, is likely associated with a more rapid decline in kidney function or progression of chronic kidney disease to end stage. There is a significant issue with unrecognized, or masked, hypertension in childhood chronic kidney disease. Recent evidence and, therefore, guidelines now suggest targeting a blood pressure of <50th percentile for age, sex, and height in children with proteinuria and chronic kidney disease. This often cannot be achieved by monotherapy and additional agents need to be added. Blockade of the renin angiotensin aldosterone system represents the mainstay of therapy, although often limited by the side effect of hyperkalemia. The addition of a diuretic, at least in the earlier stages of chronic kidney disease, might help mitigate this problem.

Keywords: chronic kidney disease, end-stage renal disease, hypertension, pediatrics, blood pressure, ambulatory blood pressure monitoring, obesity

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