An athletic adolescent girl with proteinuria and hypertension

An 18-year-old athletic adolescent presents with hypertension found during a routine screening. Her prior history includes familial hyperlipidemia. Hypertension in the adolescent is classified based on percentiles for age, sex, and height. The most common secondary cause of hypertension in the pediatric and adolescent patient is renal disease. This patient was found to have nephrotic syndrome and because of her age, a renal biopsy was required to make the diagnosis and to direct subsequent treatment plans. She was diagnosed with C3 glomerulopathy, which is the result of dysregulation and uncontrolled activation of the alternative complement pathway; new therapies are emerging for this disease. In this case, we review the diagnosis and initial assessment of hypertension in the pediatric patient, and the causes of nephrotic syndrome with a focus on C3 glomerulopathy.