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High blood pressure is common in children with chronic kidney disease (CKD). Because of their young age when they develop CKD and high blood pressure, there is a high risk that these children may eventually have heart problems and a worsening of CKD. It is very important for children with CKD to be checked for high blood pressure. Early detection and treatment of high blood pressure helps to reduce the chance of these complications. This fact sheet is written for parents of children with CKD. The booklet will tell you what you need to know about detection and treatment of high blood pressure in your child.
Chronic kidney disease means that the kidneys have been damaged by diseases such as the ones listed in the next question. As a result, the kidneys are less able to do the following jobs to help maintain health:
When the kidneys are not working well, wastes can build to high levels in the blood, causing symptoms such as swelling of the hands and feet, nausea and vomiting, fatigue and poor appetite. Complications may develop such as high blood pressure, anemia, weak bones, poor nutritional health, growth failure and nerve damage. Kidney disease also increases the chance of developing heart and blood vessel disease. These problems may happen slowly over a long period of time, often without symptoms. CKD may eventually lead to kidney failure and require dialysis or a kidney transplant to maintain life. Early detection and treatment may help to keep CKD from getting worse and prevent its complications.
In adults, the major causes of CKD are diabetes and high blood pressure. At present, these are not major causes of CKD in children. However, diabetes and high blood pressure are increasing among children, mostly because growing numbers of children are overweight. Being overweight greatly increases the risk of developing serious health problems like diabetes, high blood pressure, high blood cholesterol and CKD. Currently, the major causes of CKD in children include:
Blood pressure is the force of your blood against the walls of your blood vessels as the heart pumps blood around the body. If this pressure becomes too high, someone is said to have high blood pressure, or hypertension.
As in adults, high blood pressure is more common in children who:
When a child has high blood pressure, the doctor should check for kidney diseases (such as the ones listed earlier) as a possible cause of high blood pressure.
High blood pressure is a leading cause of CKD in adults and contributes to the worsening of CKD in children. High blood pressure can also be a complication of kidney disease. The kidneys play a key role in keeping blood pressure in a healthy range. If your child’s kidneys are damaged, they are less able to help regulate blood pressure. As a result, the child’s blood pressure increases and CKD gets worse. Making sure your child’s treatment plan is followed carefully and his/her blood pressure is controlled can help keep kidney disease from getting worse and prevent heart disease.
Your child’s blood pressure should be measured with a blood pressure cuff that is the right size for the child’s age and size. Different size cuffs are available for measuring blood pressure in children. In some cases, the doctor may want to do ambulatory monitoring of the child’s blood pressure, which means the pressure will be measured over a period of time while the child goes about normal daily activities. Special equipment is available for measuring blood pressure in newborns and infants.
Figure: Finding the correct cuff size for measuring a child’s blood pressure. The cuff bladder should cover 80% to 100% of the circumference of the arm.
As in adults, children’s blood pressure is read as two numbers. The top number, or systolic blood pressure, is the pressure when the heart is pumping blood around the body. The bottom number, or diastolic blood pressure, is the pressure when the heart is resting between beats. A blood pressure of 130/80 is read as 130 over 80.
Normal blood pressure is lower in children than in adults. Blood pressure increases with age and body size. Normal blood pressure for your child will depend on the child’s age, gender and height. The doctor will compare your child’s blood pressure to charts listing normal blood pressure ranges for boys and girls based on their age and height. A diagnosis of high blood pressure should be based on at least two readings taken at three separate visits to the doctor. Ask the doctor what your child’s blood pressure reading is and whether this is considered too high.
The goals of treating high blood pressure in your child are:
The child’s blood pressure should be reduced to a normal level for the child’s gender, age and height, or to less than 130/80, whichever is lower. Ask your child’s doctor to tell you what his/her target blood pressure number should be.
Your child’s treatment may include making lifestyle changes and taking medications. (See next question for examples of lifestyle changes.) A doctor who has special training in kidney disease and high blood pressure in children should be involved in your child’s care.
Your child’s doctor may recommend the following steps:
In deciding what blood pressure medications are best for a child with CKD, the doctor will consider:
There are many blood pressure medicines available. Many of them have been tested on children. Among these, your child’s doctor may prescribe a type of blood pressure pill called an angiotensin converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB). Some studies have suggested that these medications may help to protect kidney function. If your child has salt and water retention, diuretics (water pills) may also be prescribed. Other types of blood pressure medications, such as beta-blockers, clonidine and calcium channel blockers, may also be chosen as the first line medication to be used in combination with the other medications. Most children with high blood pressure and CKD will require more than one medication. The dose of any medication your child receives must be adjusted for the child’s age and weight.
Your child’s blood pressure should be checked every time you visit the child’s doctor. Parents can learn to take the child’s blood pressure at home, or ask the nurse at school to check it. It’s helpful to keep a record of the child’s daily blood pressure and show this to the doctor at each visit. When doing this, it is vitally important to be honest when recording the blood pressure measurement. It does not help to record what you think the doctor would like to see; you must record what you actually measure. You may obtain a copy of “Get the Facts About High Blood Pressure and Your Kidneys,” which has a chart to track your child’s blood pressure.
At follow-up visits, the doctor may do some additional tests to check the kidneys. These may include:
Speak to your child’s doctor and to other members of the health care team. You may also find the following resources from the National Kidney Foundation helpful.
Get the Facts About High Blood Pressure and Your Kidneys—a pocket card you may use to keep track of your child’s blood pressure.
For more information about kidney disease in children click here.
If you would like more information, please contact us.
©2013 National Kidney Foundation. All rights reserved. This material does not constitute medical advice. It is intended for informational purposes only. No one associated with the National Kidney Foundation will answer medical questions via e-mail. Please consult a physician for specific treatment recommendations.