HTN

Question 1

What are the stages of hypertension in paediatrics?

Answer 1

• Normal: < 90thpercentile
• Pre-HT: 90th- 95thor> 120/80
• Stage 1 HTN: 95th- 99th+ 5 mmHg
• Stage 2 HTN: > 99th+ 5 mmHg

Question 2

What are some secondary causes of HTN in paediatrics?

Answer 2

• Renal (75%) - post-infectious glomerulonephritis, chronic glomerulonephritis, obstructive uropathy, reflux nephropathy, reno-vascular, haemolytic uraemic syndrome, polycystic kidney disease
• Cardiovascular (15%) - coarctation of the aorta
• Endocrine (5%) - phaeochromocytoma, hyperthyroidism, congenital adrenal hyperplasia, primary hyperaldosteronism, Cushing syndrome
• Other (5%) - neuroblastoma, neurofibromatosis, steroid therapy, raised intracranial pressure.

Question 3

What is a classic derm sign of neurofibromatosis?

Answer 3

Cafe-au-lait spots

Question 4

What are some initial and further Ix you might run to investigate HTN.

Answer 4

Initially: urine analysis, urine microscopy, urea and electrolytes, creatinine

Further investigations may include: urinary catecholamines, chest X-ray, ECG, renal ultrasound, gluconate scan, plasma renin pre- and post- captopril, thyroid function tests, cortisol / aldosterone levels, 17-hydroxy progesterone, renal angiography.