Renal factors in juvenile hypertension

Essential hypertension in infancy, one believed to occur rarely if ever, is now increasingly recognized as a potential precursor of essential hypertension in adulthood. The mechanisms responsible for hypertension in childhood and adolescence are only beginning to be delineated. Renal factors assumed to be operative in juvenile hypertension are involving either volume control (by renal regulation of sodium-chloride and water balance) or vasoactive substances like the kallikrein-kinin, the renin-angiotensin and the prostaglandin system and other less well defined hormones. There is a close interrelationship of all these hormones with each other as well as a close linking of these vasoactive compounds to the renal regulation of sodium-chloride and water balance, thus interfering with a major environmental factor necessary for the development of essential hypertension. At present, data are insufficient to delineate a single hormone or a single hemodynamic abnormality as the only primary factor in juvenile hypertension. Further research into the pathomechanisms responsible for the elevation of blood pressure at its very beginning will improve our understanding of hypertension and possibly benefit its management by early intervention.