Hypertension in children — structured clinical encounter

A six-year-old boy is referred to your general paediatric clinic after a school entry health check recorded a blood pressure of 124/84 mmHg, above the 95th percentile for his age, sex and height. He is asymptomatic, plays football twice a week, and is on the 50th centile for weight and height. He has no relevant family history. On your measurement, seated and rested with the correct cuff, his right-arm blood pressure is 122/82 mmHg, equal in both arms, and his leg pressures are 120/80 mmHg with palpable femoral pulses and no radio-femoral delay. His urinalysis shows 2+ protein and 1+ blood. His urea and electrolytes are normal and his creatinine is 62 micromoles per litre, at the upper limit of normal for his age. A renal ultrasound shows a small left kidney of seven centimetres with cortical thinning and scarring, and a normal right kidney of nine centimetres. You are the paediatric registrar working through the assessment, investigation and management with the family.