Arterial Hypertension in Children with Chronic Kidney Diseases

Abstract

Arrterial hypertension (HTN) is one of the most common sequelae of chronic kidney disease (CKD) in children. In children with chronic kidney disease (CKD) HTN is several times higher than in the general pediatric population. With progression of CKD, HTN increases, reaching 45-60% in dialysis patients. The regulation of hypertension in children is mandatory in the treatment of CKD due to the fact that hypertension is often goes unrecognized, insufficiently controlled and often masked. The etiology of hypertension is different depending on the age of diagnosis. In newborns and young children, hypertension occurs due to renovascular diseases such as renal venous thrombosis, renal artery stenosis and other renal parenchymal diseases. HTN is considered a marker for disease severity in CKD and is a risk factor for accelerated deterioration of kidney function as well as for cardiovascular disease. Activation of the renin–angiotensin–aldosterone system plays a pivotal role in renal hypertension. Оbesity and hyperuricemia are the risk factors for HTN in CKD in children and lead to the progression of CKD. HTN-induced target organ damage (TOD) manifests as microalbuminuria/proteinuria, retinopathy, increase in intima media thickness, atherosclerosis, reduced arterial compliance, cognitive impairment, and left ventricular hypertrophy (LVH). In adults and children with CKD, ABPM has been found to be superior than causal blood pressure to diagnose hypertension and to monitor adequacy of treatment. The main drug therapy used in children with HTN and CKD consists of ACE inhibitors. Strict BP control and limitation of proteinuria with ACE inhibitors and angiotensin receptor blockers (ARB) can slow the progression of CKD.