6657 Peds Week 7: Genitourinary/Renal|Advanced Pediatric Nephrology, Urologic Disorders, and Genitourinary Clinical Management Examination: Pediatric Blood Pressure Percentile Assessment and Hypertension Screening Guidelines, Oscillometric Versus Ausculta

6657 Peds Week 7: Genitourinary/Renal|Advanced Pediatric Nephrology, Urologic Disorders, and Genitourinary Clinical Management Examination: Pediatric Blood Pressure Percentile Assessment and Hypertension Screening Guidelines, Oscillometric Versus Auscultatory Blood Pressure Confirmation in Children, Primary and Secondary Pediatric Hypertension Etiologies and Cardiovascular Risk Evaluation, Ambulatory Blood Pressure Monitoring for Hypertension Diagnosis, Lifestyle Modification and Pharmacologic ACE Inhibitor Therapy for Pediatric Hypertension, Pediatric Proteinuria Classification and Orthostatic Proteinuria Evaluation, Glomerular Versus Tubular Proteinuria Pathophysiology and Diagnostic Workup, Post-Streptococcal Glomerulonephritis and Immune-Mediated Renal Inflammation, Nephrotic Syndrome Pathophysiology With Hypoalbuminemia Edema and Hyperlipidemia, Pediatric Hematuria Evaluation and Differentiation of Glomerular Versus Lower Urinary Tract Bleeding Exam Questions Verified and Provided with Complete A+ Graded Rationales Latest Updated 2026 Blood pressure in children Foundation: Blood pressure increases with age The cuff bladder length should encircle 80% to 100% of the arm •Leg measurement until arm size is achieved BP should be measured annually in children and adolescents ≥3 years of age • 3 y of age if at risk BP should be checked in all children and adolescents ≥3 y of age at every health care encounter if: •Obese •Taking medications known to increase BP •Have renal disease •History of cardiac disease •Diabetic Oscillometric devices may be used for BP screening in children and adolescents for screening. •Providers should use a device that has been validated in the pediatric age group. •If elevated BP is suspected on the basis of oscillometric readings, confirmatory measurements should be obtained by auscultation Elevated readings vs. HTN establishing a diagnosis Pediatric definition: Elevated blood pressure that persists on repeated measurements at 95th percentile for age, height and sex •Separate range for male and female •Measurement on all extremities •Measurements from three separate occasions (average) Primary causes •Obesity, Familial Secondary causes (examples) •Coarctation of the aorta, Bronchopulmonary dysplasia, Patent ductus arteriosus •Studies have demonstrated increased prevalence of learning disabilities in children with primary HTN compared with normotensive Diagnosis Ambulatory monitoring for confirmation •Pros and Cons Laboratory Evaluation (R/O renal dysfunction) •U/A •CBC •BUN - Creatinine •Electrolytes •Glucose Imaging: R/O congenital abnormalities: •Echocardiogram - e.g. coarctation of the aorta •US (color doppler) - e.g. renal artery stenosis Pre-hypertension vs. hypertension Age/development dependent Lifestyle Changes (mild to moderate) •Think 5-2-1-0 •Nutrition referral •Improve sleep •Reduce sodium intake •Goal: BP to 95th percentile for age, sex & weight Sports participation and increased physical activity should be encouraged in children with HTN Restriction on 'high static/dynamic' activity - When Systolic/Diastolic is 5mm above the 99th percentile Pharmacologic management •When lifestyle change has failed When systolic and diastolic are 5mm than 99th percentile •Referral needed per AAP, 2018 (cardiology or nephrology); What happens while waiting for pre-authorization, etc? Drug of choice •ACE inhibitor (Lisinopril most common and given qd vs e.g. Captopril at tid-qid and more effective for pediatric primary than ARBs •Lisinopril 0.07mg/kg/d Max 40mg/d BP pharm in children •ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, hydrochlorothiazide, and the mineralocorticoid receptor antagonist (eplerenone) were evaluated compared to placebo. •Only ACE inhibitors and ARBs were found to significantly outperform placebo for both SBP and DBP. •Additionally, ACE inhibitors were significantly better at lowering DBP Proteinuria transient vs fixed (persistent); can be glomerular (most common) or tubular Diagnosis is based upon presence or absence of associated symptoms: Hematuria, HTN, Azotemia Transient associated symptoms: fever, exercise, stress, dehydration, seizures Transient proteinuria Often associated with vigorous experience Postural/orthostatic - cause unknown, no edema, HTN or hematuria