Introduction:
Accelerated hypertension is not uncommon in children. Accelerated hypertension is associated with significant morbidity and mortality in children. It is caused by renal disease and endocrine disease in children. Children present with head ache, dyspnoea, visual blurring, edema and renal dysfunction. There is paucity of literature on outcome of accelerated hypertension in children. Therefore we conducted this study in hospitalized children who presented with accelerated hypertension
Methods:
The study population comprised of 37 children who were admitted with accelerated hypertension in nephrology and paediatrics department with diagnosis of accelerated hypertension at our tertiary care institute. Study duration was from April 2017 to December 2023.Demographic data of children was recorded. All relevant investigations like urea/ creatinine, CBC, Liver function test. Urine examination and urine protein creatinine ratio were recorded. Fundus examination was done by ophthalmologist. Accelerated hypertension was diagnosed if fundus showed either haemorrhages and exudates or papilledema or both. Ultrasound findings were also recorded. BP recordings were also reviewed. The parenteral drugs used for control of BP were also reviewed. BP recordings and relevant investigations were also noted at last follow up. Appropriate statistical methods were used to analyse data.
Results:
Study cohort comprised of 37 children. The gender ratio was 22:15 (male: female}. Mean age of patients was 12.4+ 4.5 years. The cohort had mean s. creatinine and BUN of 2.2 + 1.8 mg % and 31.3 + 5.2 mg%. Their mean Haemoglobin was 11.5 2.1 %. The cohort had mean 24 hour proteinuria of 1.3 gm + .7 gm. Mean systolic BP was 174 + 18.5 mm Hg and Diastolic BP was 98 + 11.4 mm Hg . Most patients (89 %) had hypertension due to renal parenchymal disease (RPD) while 6.5 % had renovascular disease and 2.5 % had essential hypertension. Post infectious glomerulonephritis (PIGN), Thrombotic microangiopathy (TMA) and IgA nephropathy were most common causes of RPD. Lupus nephritis, Focal segmental glomerulosclerosis, Membranoproliferative GN and reflux nephropathy were seen in remaining patients. All 3 patients of renovascular disease had aortoarteritis. Head ache (45.9%) was most common presenting symptom. Other symptoms were blurred vision (24%), vomiting (13.5%) and dyspnoea (11%). Fifteen patients (40%) had oliguria. Twenty patients needed dialysis support. Labetalol and nitro glycerine infusion were used to control blood pressure. Mean time to control of BP was 3.5 + 1.2 days. Six patients had normalization of BP. Five (13.5%) patients died. Eight patients (21.6%) remained dialysis dependent. Mean follow up was 34+5.4 months. Mean s. creatinine was 2.1 +1.3 mg% was at last follow up . Twenty (62.5 %) patients achieved control of BP. Univariate analysis revealed that Proteinuria of more than 500 mg daily, dialysis dependency at 2 weeks , Hb < 7.5 gm% and uncontrolled BP after 2 weeks were associated with dialysis dependency. Mulivariate analysis showed proteinuria > 500 mg daily and dialysis dependency at 2 weeks were associated with dialysis dependency.
Conclusions:
Accelerated hypertension in children is mostly due to renal parenchymal disease. PIGN , Ig A nephropathy and TMA are common causes for this entity. Sixty two patients had achieved control of BP. Univariate analysis showed significant proteinuria, dialysis dependency at 2 weeks, Hemoglobin < 7.5 gm% and uncontrolled BP at 2 weeks were predictive of dialysis dependency but only proteinuria and dialysis requirement at 2 weeks were significant in multivariate analysis.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.