At the bottom of the differential diagnosis list: unusual causes of pediatric hypertension

Grinsell, Matthew M.; Norwood, Victoria F.

doi:10.1007/s00467-008-0744-y

Cited by 28 publications

(12 citation statements)

References 84 publications

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“…Second, we investigated children and adolescents aged 11-17. It has been reported that before the age of 11, the most frequent cause of hypertension is renoparenchymal disease and that essential hypertension is more common thereafter [30]. One large study in Turkey reported a prevalence of hypertension of 0.6% among the children investigated, with 81.8% of participants having essential hypertension [31].…”

Section: Discussionmentioning

confidence: 99%

Anthropometric risk factors for elevated blood pressure in adolescents in Turkey aged 11–17

et al. 2010

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To investigate the relationship between anthropometric parameters and elevated blood pressure in adolescents, we measured blood pressure (BP), height, weight, triceps skinfold (TSF) thickness, waist circumference (WC), and mid-upper-arm circumference (MUAC) in 2,860 student volunteers aged 11-17 years in Kayseri, Turkey. Waist-to-height ratio (WHtR), waist-to-arm-span ratio (WASR), body mass index (BMI), arm-fat area (AFA), and fat percentage (FP) were also calculated. Participants were divided into two groups: hypertensive [systolic blood pressure (SBP) or diastolic blood pressure (DBP) ≥ 95th percentiles, n = 246] and normotensives (SBP or DBP < 95th percentiles, n = 2614). Multiple logistic regression models were produced within these groups for the examined risk factors, and cutoff points were investigated for SBP or DBP ≥ 95th percentiles using receiver operating characteristics (ROC) analysis. BMI, WC, WHtR, WASR, MUAC, and BMI had statistically significant cutoffs among boys. Whereas BMI, WHtR, WASR, WC, MUAC, AFA, and TSF were statistically significant for girls younger than 15, only BMI and WC were statistically significant for participants older than 15. The independent risk factors for elevated BP were determined according to BMI and WC. Although several anthropometric measurements were significant in our participants, BMI and WC were significant among all participants irrespective of age and sex.

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Section: Discussionmentioning

confidence: 99%

Anthropometric risk factors for elevated blood pressure in adolescents in Turkey aged 11–17

et al. 2010

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“…Primary hyperparathyroidism, which is rare in children, can result in severe hypercalcemia and hypertension [45]. Although the mechanism is not clear, in patients with chronic kidney disease (CKD) and ESKD, tertiary hyperparathyroidism may contribute to severe hypertension.…”

Section: Hypertension and Hypercalcemiamentioning

confidence: 99%

Hypertensive crisis in children

Chandar

Zilleruelo

2011

Pediatr Nephrol

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Hypertensive crisis is rare in children and is usually secondary to an underlying disease. There is strong evidence that the renin-angiotensin system plays an important role in the genesis of hypertensive crisis. An important principle in the management of children with hypertensive crisis is to determine if severe hypertension is chronic, acute, or acute-on-chronic. When it is associated with signs of end-organ damage such as encephalopathy, congestive cardiac failure or renal failure, there is an emergent need to lower blood pressures to 25-30% of the original value and then accomplish a gradual reduction in blood pressure. Precipitous drops in blood pressure can result in impairment of perfusion of vital organs. Medications commonly used to treat hypertensive crisis in children are nicardipine, labetalol and sodium nitroprusside. In this review, we discuss the pathophysiology, differential diagnosis and recent developments in management of hypertensive crisis in children.

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“…7,14 In paediatrics, the diagnostic process is complex due to both the biochemical heterogeneity of these tumours and the scarcity of appropriate reference values for catecholamines and their derivatives, especially in the young child. 15 No age-related reference ranges for free metadrenalines in random urine specimens currently exist in the paediatric literature. In order to better inform the diagnostic process, the purpose of the present laboratory-based study was to provide up-to-date, age-related medical decision limits for free catecholamines and their metabolites, including their methylated derivatives, in untimed urine specimens obtained from a relatively large number of subjects.…”

Section: Introductionmentioning

confidence: 99%

Age-related medical decision limits for urinary free (unconjugated) metadrenalines, catecholamines and metabolites in random urine specimens from children

et al. 2011

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Background: Neuroblastoma is the most common extracranial solid tumour in childhood (8% of all childhood cancers), the most frequently diagnosed in infancy, and has one of the highest death rates, while chromaffin tumours rarely present in childhood. Both tumour types produce catecholamines and their metabolites. It is difficult to produce reference ranges for tests in children, and currently, no age-related medical decision limits for free metadrenalines (free metanephrines) in random urine specimens exist in the paediatric literature. Methods: Results of vanillylmandelic acid (VMA), 5-hydroxyindoleacetic acid, homovanillic acid (HVA), noradrenaline (NA), adrenaline, dopamine (DA), free normetadrenaline (fNMA), free metadrenaline and free 3-methoxytyramine (f3MT) in 1658 random urines obtained from infants, children and young adults were measured by high performance liquid chromatography with electrochemical detection. Specimens were excluded from consideration if obtained from the following categories, i.e. (a) harbouring neuroblastic, chromaffin, carcinoid or other tumours or malignancies; (b) medical conditions having known association with excess catecholamine excretion; (c) patients administered catecholamine or paracetamol; (d) overly dilute urine; and (e) manifesting outlying values following visual inspection. Results: There remained 872 specimens that were grouped into seven age ranges (,1; 1 or 2; 3 or 4; 5 -7; 8 -10; 11-13; 14-19 y) for which medical decision limits were determined for each analyte. There was no significant difference between the results for boys or girls. In 55 patients harbouring neuroblastic tumours, HVA (54/55), f3MT (14/16), VMA (45/53) and DA (43/53) were the most frequently elevated analytes at time of diagnosis. In 11 patients presenting in childhood with chromaffin tumours, fNMA (11/11) followed by NA (10/11) were the most frequently elevated. Discussion: The likely reasons for outlying or missing values, together with the reasons for variation in the distinctive biochemical patterns of analytes exhibited in individuals harbouring either neuroblastic or chromaffin tumours are discussed.

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At the bottom of the differential diagnosis list: unusual causes of pediatric hypertension

Cited by 28 publications

References 84 publications

Anthropometric risk factors for elevated blood pressure in adolescents in Turkey aged 11–17

Anthropometric risk factors for elevated blood pressure in adolescents in Turkey aged 11–17

Hypertensive crisis in children

Age-related medical decision limits for urinary free (unconjugated) metadrenalines, catecholamines and metabolites in random urine specimens from children

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