The Evaluation of a 19-Year-Old With Hypertension and Proteinuria: A Case Report

Abstract

A 19-year-old male presented to the clinic and was found to be prehypertensive and have proteinuria on urine testing. He was subsequently diagnosed with focal segmental glomerulosclerosis (FSGS). Initial workup for pediatric hypertension includes urinalysis, chemistry panel, lipid panel, and renal ultrasound. Abnormalities on urinalysis, including proteinuria, hypercholesterolemia, and low serum albumin in children are characteristic of nephrotic disease. FSGS is a type of kidney pathology that often contributes to nephrotic disease and results from a variety of causes. For the primary care provider, being aware of the guidelines for pediatric hypertension screening and evaluation is important as 20% of children with hypertensive disease are due to kidney disease. FSGS is the third leading cause of end-stage renal disease in children aged 12 to 19 years, and its incidence was found to be rising in a study of Olmsted County, MN residents. Treatment to complete or partial remission of the proteinuria can slow the progression of renal disease. In this case report, we will discuss the evaluation of pediatric hypertension workup with proteinuria, specifically due to FSGS, and review current management strategies.

Blood Pressure Differences in Nephrotic Syndrome Patients with Steroid Resistant Nephrotic Syndrome Patients and Steroid Sensitive Nephrotic Syndrome

“…This compares with a 2011 study in Bangladesh in which there were more hypertension events found in the SRNS group than SSNS (p > 0.05) [2] and in line with research in Indonesia 2016 where blood pressure found in the SSNS group was higher than the SRNS group but not statistically meaningful [3]. Another study by Mamesah 2019 found the average systolic and diastolic blood pressure of the SRNS group compared to the SSNS group [9]. Other studies that support our study have a high prevalence of hypertension in the SRNS and SSNS groups where the prevalence of hypertension in different patient populations with SNs ranges from 8% to 59.1% [14].…”

“…The incidence of hypertension in children is about 20% caused by kidney disease [9]. Hypertension can be found in disease condition or in the course of NS disease due to steroid toxicity [1].…”

“…Almost the same research was also conducted by Mamesah et al at RSUP Prof Dr. R. D. Kandou Manado. They found that SRNS patients had a higher average systolic and diastolic blood pressure than SSNS, and this incidence of hypertension was not associated with the incidence of SRNS and SSNS [9]. There were differences in blood pressure in both the SRNS and SSNS groups from several studies to see the difference in blood pressure of SSNS and SRNS sufferers at The General Hospital of Haji Center Adam Malik Medan.…”