Master the board step 3

Pediatrics
Hypertension
Hypertension in pediatrics is based on the nomogram and falls into 4 categories:
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Normal: ≤ 90 percent
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Pre-hypertension: > 90 to ≤ 95 percent
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Stage I: > 95 to ≤ 99 percent
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Stage II: ≥ 99 percent + BP 5 mm Hg
Routine blood pressure checks are recommended beginning at age 3. On exam,
be sure to check all 4 extremities (to look for coarctation).
Always work up for secondary hypertension under the following circumstances:
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Newborns: Umbilical artery catheters → renal artery/vein thrombosis.
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Early childhood: Renal parenchymal disease, coarctation, endocrine, medications
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Adolescents: Essential hypertension is associated with obesity.
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Evaluate for renal and renovascular hypertension.
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Majority of causes of renovascular hypertension may be due to urinary
tract infection (secondary to an obstructive lesion), acute glomerulonephritis,
Henoch-Schönlein purpura with nephritis, hemolytic uremic
syndrome, acute tubular necrosis, renal trauma, leukemic infiltrates, mass
lesions, and renal artery stenosis.
Consider renal causes of hypertension in every pediatric patient presenting
with hypertension.
Diagnostic Testing
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Screening tests:
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CBC
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Urinalysis
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Urine culture
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Electrolytes
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Glucose
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BUN
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Creatinine
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Calcium
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Uric acid
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Lipid panel with essential hypertension and positive family history
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Echocardiogram for chronicity (left ventricular hypertrophy)
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Kidney evaluation:
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Renal ultrasound
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Voiding cystourethrogram, if there is a history of repeated UTIs (especially
< 5 years)
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