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Background Hypertensive crisis occurs in 1-4% of the hypertensive pediatric population, mostly due to acute glomerulonephritis (AGN). Some factors have been suggested to affect blood pressure (BP) in children, such as age, sex, race/ethnicity, obesity, and socioeconomic status, but little is known for risk factors for hypertensive crisis in AGN.
Objective To analyze the risk factors for hypertensive crisis in children with AGN.
Methods Retrospectively, we studied possible risk factors for hypertensive crisis in children with AGN at Dr. Soetomo Hospital from 2007 to 2011. Hypertensive crisis was defined as systolic BP ≥180 mmHg or diastolic BP ≥120 mmHg (for children ≥ 6 years of age); and systolic and/or diastolic BP >50% above the 95th percentile (for children aged <6 years). We evaluated the demographic and clinical characteristics as potential risk factors. Statistical analysis was done with Chi-square, Fisher’s exact, and logistic regression tests. Variables with P <0.25 in the univariable analysis were further analyzed by the multivariable logistic regression model. A P value of < 0.05 was considered statistically significant.
Results There were 101 children included (mean age 9.7 (SD 2.17) years), with a male-to-female ratio of 2.7:1. Hypertensive crisis occurred in 42 (41.6%) children, of whom 8 had hypertensive urgency and 34 had hypertensive emergency. Proteinuria was seen in 53 children with AGN (52.5%) and was the significant risk factor for hypertensive crisis in our subjects (OR=2.75; 95%CI 1.16 to 6.52; P=0.021). Gender, clinical profiles, ethnicity, nutritional status, blood urea nitrogen (BUN), and glomerular filtration rate (GFR) were not significant risk factors for hypertensive crisis.
Conclusion Proteinuria is the significant risk factor for hypertensive crisis in children with AGN.
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2. McNiece KL, Poffenbarger TS, Turner JL, Franco KD, Sorof JM, Portman RJ. Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr. 2007;150:640-4.
3. Jackson LV, Thalange NK, Cole TJ. Blood pressure centiles for Great Britain. Arch Dis Child. 2007;92:298-303.
4. National High Blood Pressure Education Program Working Group on Hypertension Education in Children and Adolescents. Update on the 1987 Task Force Report on High Blood Pressure in Children and Adolescents: a working group report from the National High Blood Pressure Education Program. Pediatrics. 1996;98:649-58.
5. Lauer RM, Clarke WR. Childhood risk factors for high adult blood pressure: the Muscatine Study. Pediatrics. 1989;84:633-41.
6. Sorof JM, Lai D, Turner J, Poffenbarger T, Portman R. Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics. 2004;113:475-82
7. Brewer ED. Evaluation of hypertension in childhood diseases. In: Avner ED, Harmon WE, Niaudet P, Yoshikawa N, editors. Pediatric nephrology. 6th ed. Berlin-Heidelberg: Springer; 2009. p. 1519-40.
8. Sumboonnanonda A, Chongcharoensuk C, Supavekin S, Pattaragarn A. Persistent hypertension in Thai children: etiologies and outcome. J Med Assoc Thai. 2006;89:28-32.
9. Kumar GV. Clinical study of post streptococcal acute glomerulonephritis in children with special reference to presentation. Curr Pediatr Res. 2011;15:89-92.
10. Kearns T, Evans C, Krause VL. Outbreak of acute post-streptococcal glomerulonephritis in the Northern Territory, 2000. Northern Territory Dis Control Bull. 2001;8:6-14.
11. Centers for Disease Control and Prevention, National Center for Health Statistics 2000 CDC Growth Charts: United States. 2002; [cited June 26, 2013]. Available from: www.cdc.gov/growthcharts/.
12. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114:555-76.
13. Heird WC. Parental feeding behavior and children’s fat mass. Am J Clin Nutr. 2002;75:451-2.
14. Welch TR. An approach to the child with acute glomerulonephritis. Int J Pediatr. 2012;115:1-3.
15. Derakhshan A, Hekmat VR. Acute glomerulonephritis in Southern Iran. Iran J Pediatr. 2008;18:143-8.
16. Etuk IS, Anah MU, Eyong ME. Epidemiology and clinical features of glomerulonephritis in Calabar, Nigeria. Niger J Physiol Sci. 2009;24:91-4.
17. Rames L, Clarke WR, Connor WE, Reiter MA, Lauer RM. Normal blood pressure and the evaluation of sustained blood pressure elevation in childhood: the Muscatine Study. Pediatrics. 1978;61:245-51.
18. Cervantes J, Acoltzin C, Aguayo A. Diagnosis and prevalence of arterial hypertension in persons under 19 years of age in the city of Colima. Salud Publica Méx. 2000;42:529-32.
19. Hirose H, Saito I, Tsujioka M, Mori M, Kawabe H, Saruta T. The obese gene product, leptin: possible role in obesity-related hypertension in adolescents. J Hypertens. 1998;16:2007-12.
20. D’Amico G, Bazzi C. Pathophysiology of proteinuria. Kidney Int. 2003;63:809-25.
21. Eddy AA. Proteinuria and interstitial injury. Nephrol Dial Transplant. 2004;19:277-81.