Table 4.
General features of children and adolescents suggestive of a secondary cause of hypertension
| Medical history |
| • Family history of secondary disorders of hypertension, hyperlipidemia, or cardiovascular events in early life |
| • Use of medications or drugs contributing to hypertension |
| • Absence of dietary and other lifestyle risk factors for hypertension |
| • History of renal or cardiovascular disorders |
| • Absence of sleep disorders |
| • Urinary tract infections or unexplained fevers in infancy |
| • Symptoms of hypertension: severe recurrent occipital headache, cardiac decompensation, acute visual disturbances |
| Physical examination |
| • Absence of obesity |
| • Preadolescence |
| • Stage II hypertension with combined systolic and diastolic BP rise |
| • Retinal vascular changes |
| • Higher pulse intensity and BP in upper than in lower extremities |
| • Low pulse rate and blanched or cool skin |
| • Periumbilical bruit |
| • Abdominal mass |
| • Thyromegaly |
| • Cutaneous lesions suggestive of specific disorders associated with hypertension, such as tuberous sclerosis, neurofibromatosis, Williams syndrome, Marfan syndrome, Turner syndrome, Cushing syndrome, acanthosis nigricans, skin flushing, pallor, diaphoresis, palpitations |
| Laboratory studies |
| • Increased serum creatinine concentration |
| • Abnormal serum potassium, high calcium, or other electrolyte disorders |
| • Urinalysis showing pyuria, proteinuria, hematuria, or casts |
| • Normal or low serum uric acid level (in the absence of renal dysfunction) |
| • Low C3, and high ANA, double stranded anti-DNA or ANCA titers |
| • High fasting serum lipids |
| • Abnormal urinary VMA or HVA excretion or high plasma metanephrines |
| • Abnormal peripheral plasma renin activity, cortisol, aldosterone, T4, thyroid-stimulating hormone |
| Imaging studies |
| • Renal ultrasound showing asymmetry in kidney size, renal masses, increased echotexture, hydronephrosis; high arterial resistive indices on Doppler study |
| • Dimercaptosuccinic acid scan showing renal scarring |
| • Voiding cystorethrography showing vesicoureteral reflux |
| • Magnetic resonance or computer tomography angiography revealing renal artery stenosis or aortic coarctation |
| • Echocardiography |
| • Increased left ventricular mass index; decreased LV function |
Abbreviations: ANA, antinuclear antibodies; ANCA, antineutrophil cytoplasmic antibodies; BP, blood pressure; LV, left ventricular; VMA, vanillylmandelic acid; HVA, homovanillic acid.