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Int J Nephrol Renovasc Dis. 2017 Jul 26;10:205-213. doi: 10.2147/IJNRD.S100891. eCollection 2017.

Hypertension in pediatric patients with chronic kidney disease: management challenges.

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Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Faculty of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.


In contrast to adults where hypertension is a leading cause of chronic kidney disease, in pediatrics, hypertension is predominantly a sequela, however, an important one that, like in adults, is likely associated with a more rapid decline in kidney function or progression of chronic kidney disease to end stage. There is a significant issue with unrecognized, or masked, hypertension in childhood chronic kidney disease. Recent evidence and, therefore, guidelines now suggest targeting a blood pressure of <50th percentile for age, sex, and height in children with proteinuria and chronic kidney disease. This often cannot be achieved by monotherapy and additional agents need to be added. Blockade of the renin angiotensin aldosterone system represents the mainstay of therapy, although often limited by the side effect of hyperkalemia. The addition of a diuretic, at least in the earlier stages of chronic kidney disease, might help mitigate this problem.


ambulatory blood pressure monitoring; blood pressure; chronic kidney disease; end-stage renal disease; hypertension; obesity; pediatrics

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Disclosure The authors report no conflicts of interest in this work.

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