Persistent severe hypertension in an infant with posterior urethral valves

Severe hypertension, an infrequent problem in pediatrics, usually has a single secondary cause. We report an infant with severe hypertension and left reflux nephropathy, a known cause of secondary hypertension. The severity of hypertension and poor response to pharmacological therapy prompted further investigation, including a renal arteriogram that showed a right segmental renal artery stenosis.