Childhood hypertension

RVD is an important cause of childhood hypertension. When certain clinical and/or imaging findings suggest RVD, children with hypertension should be referred to a multidisciplinary paediatric renovascular team for consideration of endovascular therapy. 

Lack of access to medicines and inappropriate doses result in serious morbidity and mortality, particularly for childhood infections and chronic diseases, such as hypertension, diabetes, epilepsy and mental disorders. Inappropriate use and over-use of medicines waste resources - often out-of-pocket payments by patients - and result in significant patient harm in terms of poor patient outcomes and adverse drug reactions. Furthermore, over-use of antimicrobials is leading to increased antimicrobial resistance and non-sterile injections to the transmission of hepatitis, HIV/AIDS and other blood-borne diseases. Finally, irrational over-use of medicines can stimulate inappropriate patient demand, and lead to reduced access and attendance rates due to medicine stock-outs and loss of patient confidence in the health system. 

Complications Blunt abdominal trauma increases the risk of rupture, which can also occur spontaneously. The mortality rate is 60-80%. (71) Large shunt volumes may give rise to the development of cardiac insufficiency, particularly during childhood. The development of portal hypertension has also been observed. (92) Anaemia, thrombopenia and hypofibrinogenaemia may occur due to the haemangioma-thrombocytopathy syndrome (= Kasabach-Merritt syndrome). (82)... 

Hu H. A 50-year follow-up of childhood plumbism hypertension, renal function, and hemoglobin levels among survivors. Am J Dis Child 1991 145 681-687. 

Anorexia, vomiting, malaise, and convulsions (due to increased intracranial pressure) are most commonly seen in children. Sources of childhood exposures are typically environmental such as to paint chips, pottery, drinking water, and dust. Acute exposure in adults may cause gastrointestinal effects, pain in arms and legs, and hypertension. Exposure to very high levels may cause tremor, memory loss, confusion, stupor, renal failure, convulsions, and coma. 

Joint statement for physicians by the Committee on Atherosclerosis and Hypertension in Childhood of the Council on Cardiovascular Disease in the Young and the Nutrition Committee, American Heart Association Diagnosis and treatment of primary hyperlipidemia in childhood. Circulation 1986 74 1181-A. 

Information gathered should include all medical problems the patient receives treatment for such as hypertension and diabetes. Problems the patient has been treated for in the past and past surgical procedures should also be noted. In children, it is important to include childhood illnesses (i.e., mumps, chicken pox) and exposure to these as well. 

Osmond C, Barker DJ (2000) Fetal, infant, and childhood growth are predictors of coronary heart disease, diabetes, and hypertension in adult men and women. Environ Health Perspect 108(Suppl 3) 545-553. Jones PA, Laird PW (1999) Cancer epigenetics comes of age. Nat Genet 21(2) 163-167. Dawson MA, Kouzarides T (2012) Cancer epigenetics from mechanism to therapy. Cell 150(l) 12-27... 

Proteinuria in childhood, with hypertension, etc., or tubular lesions (clearance studies are invaluable). 

Many agents can be used to treat chronic hypertension in pregnancy (Table 13-7). Methyldopa is considered the drug of choice. Data indicate that uteroplacental blood flow and fetal hemodynamics are stable with methyldopa. Moreover, it is viewed as very safe based on long-term follow-up data (7.5 years) that have not demonstrated adverse effects on childhood development. /S-Blockers, labetalol, and... 

It s possible that fetal overexposure to stress hormones causes physiological programming that endures through childhood and adulthood. Animal experiments demonstrate that prenatal stress hormone excess reduces birth weight and causes lifelong postnatal hypertension, hyperglycemia, and behavioral abnormalities.57 In fact, the scientific literature cites many animal experiments on the effects of maternal stress on fetal development, but it s difficult to interpret what these results mean for human fetal development.58... 

Largely on the basis of a review of 13 large epidemiologic studies of the general population that examined associations between renal function and BLLs under 10 pg/dL, the NTP concluded that there was sufficient evidence that BLLs under 5 pg/dL are associated with adverse effects on renal function in adults. The 13 studies support relationships between concurrent BLL and renal function. The associations are typically stronger in susceptible populations (such as people who have diabetes or hypertension). However, the NTP report concluded that concurrent BLLs in adults may reflect higher BLLs in childhood or earlier adulthood. In the absence of a study of a population in which BLLs remained under 10 pg/dL for life, the effects of early vs late lead exposnre on renal function carmot be discerned. 

Measurement of the catecholamines and a variety of the intermediate metabolites in blood or tissue is common in psychiatric and neurochemical research. In clinical chemistry the major interest in catecholamine metabolism surrounds the detection and location of the tumors of neural crest origin -phaeochromocytoma and neuroblastoma. These tumors are fortunately rare but their identification is important because if treated promptly they may be curable. Phaeochromocytoma is associated with secretion of adrenaline and/or noradrenaline into the bloodstream and can either be detected by the increase in the parent compounds or by increased VMA excretion. The most common presentation by the patient is hypertension unresponsive to conventional therapy. Neuroblastoma is the commonest malignant soft tissue tumor of childhood, arising from ectodermal neuroblasts. These tumors secrete abnormally high concentrations of dopamine which is largely metabolized to HVA. 

Susceptibility Age A range of adverse reactions were reported in 304 children (aged 4-16 years) who took epierenone for hypertension [23 ]. They were randomized to 25 mg/day, 25 mg bd, or 50 mg bd and were then re-randomized to active therapy or placebo for another 4 weeks. Adverse events were mostly mild and involved predominantly minor common childhood illnesses, of which 18 were considered severe. For example, severe adverse events in four patients (migraine, fatigue, bronchitis, and headache) were considered by the investigators to be possibly or definitely related to epierenone. Four patients... 

Queensland, Australia, young adults with childhood Pb exposures (N = 401) Deteriorated exterior Pb paint Chronic nephropathy Significantly increased rate of death from nephritis or hypertension 165/ 401 (41%) all under age 40 Henderson (1954)... 

Patients with chronic Pb nephropathy Severe childhood Pb exposures Uric acid deposits and vascular changes in kidneys Deposits and changes present in the absence of gout and hypertension Inglis et al. (1978)... 

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