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Published on: July 3, 2013
Pre-treatment considerations in childhood hypertension due to chronic kidney disease
1Wasiu Adekunle Olowu, Paediatric Nephrology and Hypertension Unit, Obafemi Awolowo University Teaching Hospitals Complex, PMB 5538, Ile-Ife, State of Osun, Nigeria.
Insights
Hypertension in children with chronic kidney disease (CKD) requires prompt management. Addressing comorbidities and medications is crucial for successful blood pressure control in pediatric CKD patients.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Health in Chronic Illness
Background:
- Hypertension (HTN) is an early and significant complication in children with chronic kidney disease (CKD).
- Elevated blood pressure (BP) in pediatric CKD is associated with accelerated kidney disease progression, increased morbidity, and mortality.
- Effective management necessitates BP persistently above the 90th percentile for age, gender, and height in non-dialyzing hypertensive children with CKD.
Purpose of the Study:
- To review the multifactorial mechanisms of HTN in pediatric CKD.
- To highlight the critical role of evaluating and managing comorbidities that influence HTN.
- To emphasize the impact of specific medications on HTN in CKD and guide towards achieving therapeutic BP targets.
Main Methods:
- Review of existing literature on hypertension in pediatric chronic kidney disease.
- Analysis of the interplay between CKD, comorbidities, and antihypertensive treatment efficacy.
- Identification of common comorbidities (anemia, volume overload, metabolic derangements) and medications (erythropoietin, immunosuppressants, NSAIDs) affecting BP control.
Main Results:
- HTN in pediatric CKD is complex, influenced by numerous interwoven factors.
- Co-morbidities such as anemia, endothelial dysfunction, hyperparathyroidism, hyperphosphatemia, and calcitriol deficiency significantly contribute to or exacerbate HTN.
- Medications including erythropoietin, cyclosporine, tacrolimus, corticosteroids, and NSAIDs can induce or worsen HTN, impacting treatment response.
Conclusions:
- Successful management of HTN in children with CKD extends beyond lifestyle changes and antihypertensive drugs.
- Prompt identification and appropriate management of contributing comorbidities and causative medications are essential for achieving target BP.
- A comprehensive approach is vital for improving outcomes in hypertensive pediatric CKD patients.
Abstract:
Hypertension (HTN) develops very early in childhood chronic kidney disease (CKD). It is linked with rapid progression of kidney disease, increased morbidity and mortality hence the imperative to start anti-hypertensive medication when blood pressure (BP) is persistently > 90(th) percentile for age, gender, and height in non-dialyzing hypertensive children with CKD. HTN pathomechanism in CKD is multifactorial and complexly interwoven. The patient with CKD-associated HTN needs to be carefully evaluated for co-morbidities that frequently alter the course of the disease as successful treatment of HTN in CKD goes beyond life style modification and anti-hypertensive therapy alone. Chronic anaemia, volume overload, endothelial dysfunction, arterial media calcification, and metabolic derangements like secondary hyperparathyroidism, hyperphosphataemia, and calcitriol deficiency are a few co-morbidities that may cause or worsen HTN in CKD. It is important to know if the HTN is caused or made worse by the toxic effects of medications like erythropoietin, cyclosporine, tacrolimus, corticosteroids and non-steroidal anti-inflammatory drugs. Poor treatment response may be due to any of these co-morbidities and medications. A satisfactory hypertensive CKD outcome, therefore, depends very much on identifying and managing these co-morbid conditions and HTN promoting medications promptly and appropriately. This review attempts to point attention to factors that may affect successful treatment of the hypertensive CKD child and how to attain the desired therapeutic BP target.
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