Table 5:

Causes and presentation of secondary HTN in children⁸

Cause		Relevant history and findings
Renal parenchymal disease	Reflux nephropathy	History of UTI, abnormal upper or lower urinary tract imaging
	Post infectious GN	Gross hematuria, edema, preceding infection, low C3
	IgA vasculitis associated nephritis	Purpuric rash, hematuria, edema
	Lupus nephritis	Edema, hematuria, malar rash, joint pain, oral ulcer, photosensitivity, Raynaud’s phenomenon
	Hemolytic uremic syndrome	Hemolytic anemia, thrombocytopenia, hematuria, renal failure
	Acute tubulointerstitial nephritis	Sterile pyuria, dysuria, fatigue
	Nephrotic syndrome	Edema
	Chronic glomerulonephritis	Proteinuria, hematuria, elevated serum creatinine
	Autosomal dominant polycystic kidney disease, Autosomal Recessive polycystic kidney disease	Palpable kidneys, USG showing renal cysts, family history of cysts
	Chronic kidney disease	Growth retardation, previous history of UTI or renal issues
Acute urinary obstruction	Pelvic ureteric junction obstruction Ureteric/bladder calculi	Flank pain, renal mass, palpable bladder, trauma
Renovascular disease	Renal artery stenosis Arteritis Renal artery or venous thrombosis	Neurofibromas, café au lait (NF), renal bruit Pulse discrepancy, claudication, Raynaud phenomenon Gross hematuria, renal mass, umbilical catheterisation
Cardiovascular	Coarctation of aorta, hypoplastic abdominal aorta syndrome	Decreased or absent femoral pulses, discrepancy in four limb BP – higher BP in upper limbs compared to lower limbs, Systolic murmur
Central nervous system	Increased intracranial pressure Spinal injury, Gullian Barre syndrome Neurofibromatosis Tuberous sclerosis	Head trauma, intracranial bleed, meningitis, bulging fontanelle and increase head circumference History of trauma, limb paralysis, loss of bowel or bladder control Café-au-lait spots Adenoma sebaceum
Endocrine	Pheochromocytoma Hyperthyroidism Hypothyroidism Cushing’s syndrome Congenital adrenal hyperplasia	Flushing, palpitations, headache, diaphoresis Weight loss, tremor, heat intolerance, thyromegaly and exophthalmos Weight gain, constipation, dry skin, cold intolerance Obesity, moon-faced, acne, hirsutism, striae Ambiguous genitalia, virilisation
Monogenic HTN	E.g., Apparent mineralocorticoid excess, Gordon’s syndrome	Failure to thrive, muscle weakness, reduced renin levels, early onset, family history
Tumor	Wilms tumor Neuroblastoma	Gross hematuria, abdominal mass
Medications and Substance abuse		Glucocorticoids, calcineurin inhibitor, sympathomimetics (salbutamol, aminophylline) growth hormone, erythropoietin, phenylephrine in decongestants, stimulants, antidepressants, hormonal contraceptives Substance Abuse (cocaine, MDMA/Ecstasy)

HTN: Hypertension, UTI: Urinary tract infection, GN: Glomerulonephritis, USG: Ultrasonography, MDMA: 3,4-methylenedioxymethamphetamine, BP: Blood pressure