Review Article

Highlights for the Management of a Child with Hypertension

Table 4

Suggested work-up for stages 1 and 2 hypertension.

ā€‰TestTo evaluate for

Blood and urine(A) Complete blood count; blood urea nitrogen, electrolytes, calcium phosphorous, and albumin(A) Renal function
(B) Plasma Renin(B) Renovascular HT
(C) Complements 3 and 4; ANA, antinuclear antibody; anti-DNA and antidouble-stranded desoxynucleic acid antibody(C) Glomerulonephritis
(D) Antineutrophil cytoplasmic antibody (ANCA); anti-GBM and antiglomerular basement membrane antibody(D) Vasculitis
(E) Thyroxine, T4; thyroid stimulating hormone, TSH; adrenocorticotrophic hormone, ACTH; OH, hydroxy; deoxycorticosterone, DOC; parathyroid hormone, PTH(E) Hormonal
(F) Serum and urinary catecholamine and metanephrines(F) Neurogenic tumors

Imaging(A) Renal ultrasound(A) Renal malformation, medical renal disease, and renal scars
(B) Mercaptoacetyltriglycine and MAG 3 scan with or without furosemide. With or without Captopril(B) Obstuctive uropathy, renovascular HT, and differential renal function
(C) Dimercaptosuccinic acid, DMSA(C) Vesicoureteral reflux and reflux nephropathy; differential renal function
(D) Voiding cystourethrogram, VCUG; digital subtraction angiography, DSA(D) Vesicouretheral reflux and structural bladder abnormalities
(E) Magnetic resonance angiography, MRA; digital subtraction angiography, DSA; computed tomographic angiography, CTA; magnetic resonance angiography, MRA(E) Renovascular
(F) MIBG, metaiodobenzylguanidine(F) Pheochromocytoma

Tests of end organ damage(A) Echocardiogram, CXR ECG(A) Cardiovascular morbidity
(B) Urinalysis(B) Proteinuria
(C) Microalbuminuria(C) Glomerular hyperfiltration
(D) Ambulatory BP monitoring(D) Absence of diurnal rhythm and white coat effect