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Curr Hypertens Rep (2014) 16:423
DOI 10.1007/s11906-014-0423-2
PEDIATRIC HYPERTENSION (JT FLYNN, SECTION EDITOR)
Treatment Strategies to Prevent Renal Damage in Hypertensive Children
Piotr Czarniak & Aleksandra Zurowska
Published online: 14 February 2014# The Author(s) 2014. This article is published with open access at Springerlink.com
Abstract Hypertension secondary to chronic kidney disease prevails in earlier childhood and obesity-related primary hyper-tension in adolescence. Both are associated with a high risk of renal and cardiovascular morbidity. In children with chronic kidney disease, uncontrolled hypertension may accelerate progression to end-stage renal disease before adulthood is reached and increase a childs risk of cardiac death a thousand-fold. Obesity-related hypertension is a slow and silent killer, and though early markers of renal damage are recognized during childhood, end-stage renal disease is a risk in later life. Renal damage will be a formidable multiplier of cardiovascular risk for adults in whom obesity and hypertension tracks from childhood. Management options to prevent renal damage will vary for these different target groups. This review provides a summary of the available renoprotective strategies in order to aid physicians involved in the care of this challenging group of children.
Keywords Hypertension . Chronic kidney disease . Obesity . Treatment . Children . Adolescents
Introduction
Kidney damage is the second-most common complication of primary hypertension after cardiovascular events, and significantly contributes to the increasing number of adults with end-stage renal disease (ESRD) [1]. In patients with established chronic kidney disease (CKD), hypertension is one of the most important predictors of further disease progression. In both primary and secondary hypertension, renal damage represents a formidable multiplier of the patients global cardiovascular (CV) risk [2].
Evidence for the above statements derives from both experimental studies and a multitude of clinical studies on end-organ damage in the adult hypertensive population for whom primary hypertension is a major issue and diabetes a major cause of CKD. Most of the existing strategies to prevent renal damage and cardiovascular events in primary hypertension and CKD patients are also based on studies from adult populations. In childhood, the causes and epidemiology of both hypertension and chronic kidney disease differ from those observed in later life.
In younger children, hypertension secondary to renal disease prevails, with primary hypertension becoming a major issue in adolescence...