Pre-treatment considerations in childhood hypertension due to chronic kidney disease

Figure 1 Prevalence of hypertension by chronic kidney disease stage in children. Data for this Figure were obtained from reference[3]. CKD: Chronic kidney disease.

Figure 2 Pathophysiologic mechanisms of hypertension in chronic kidney disease. A: Volume overload is associated with increase in cardiac output (CO) which ultimately leads to hypertension; B: Increase in total peripheral resistance (TPR) due to systemic vasoconstriction leads to hypertension; C: Arterial tunica media calcification causing vascular stiffening and failure of vasodilatation and vasoconstriction are illustrated. Chronic hyperparathyroidism promotes vascular wall mineralization or calcification leading to vascular stiffening and increase in TPR with consequent hypertension. Blood pressure = CO × TPR. RAAS: Renin-angiotensin-aldosterone system; ANG II: Angiotensin II; ET-1: Endothelin 1; PTH: Parathyroid hormone.