Hypertension in Chronic Kidney Disease

  • Susan M. HalbachEmail author
Reference work entry


Hypertension is a common feature of pediatric chronic kidney disease (CKD) and is associated with CKD progression, early markers of cardiovascular disease, and impaired neurocognitive functioning. Prospective research has demonstrated that the prevalence of hypertension in this population is higher than previously thought and that hypertension is frequently underdiagnosed and undertreated. Identifying and treating hypertension in children with CKD require familiarity with the use of pediatric normative blood pressure values and clinical guidelines as well as correct measurement technique. This includes the application of ambulatory blood pressure monitoring (ABPM), which can be helpful in both diagnosis and management. Agents which target the renin-angiotensin-aldosterone system (RAAS) are recommended as first-line therapy to treat hypertension in children with CKD, though multiple medications may be required to achieve sufficient BP control.


Blood pressure Hypertension Chronic kidney disease Child Adolescent Cardiovascular 


  1. Baracco R, Mattoo TK (2014) Pediatric hypertensive emergencies. Curr Hypertens Rep 16:456PubMedGoogle Scholar
  2. Barletta GM, Flynn J, Mitsnefes M et al (2014) Heart rate and blood pressure variability in children with chronic kidney disease: a report from the CKiD study. Pediatr Nephrol 29:1059–1065PubMedPubMedCentralGoogle Scholar
  3. Baylis C (2012) Nitric oxide synthase derangements and hypertension in kidney disease. Curr Opin Nephrol Hypertens 21:1–6PubMedPubMedCentralGoogle Scholar
  4. Becker GJ, Wheeler DC (2012) KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int 2:S337–S414Google Scholar
  5. Blydt-Hansen TD, Pierce CB, Cai Y et al (2014) Medication treatment complexity and adherence in children with CKD. Clin J Am Soc Nephrol 9:247–254PubMedGoogle Scholar
  6. Brady TM, Schneider MF, Flynn JT et al (2012) Carotid intima-media thickness in children with CKD: results from the CKiD study. Clin J Am Soc Nephrol 7:1930–1937PubMedPubMedCentralGoogle Scholar
  7. Briet M, Boutouyrie P, Laurent S et al (2012) Arterial stiffness and pulse pressure in CKD and ESRD. Kidney Int 82:388–400PubMedGoogle Scholar
  8. Butani L, Morgenstern BZ (2003) Are pitfalls of oscillometric blood pressure measurements preventable in children? Pediatr Nephrol 18:313–318PubMedGoogle Scholar
  9. Cha RH, Kim S, Ae YS et al (2013) Association between blood pressure and target organ damage in patients with chronic kidney disease and hypertension: results of the APrODiTe study. Hypertens Res 37:172–178PubMedGoogle Scholar
  10. Chavers BM, Solid CA, Daniels FX et al (2009) Hypertension in pediatric long-term hemodialysis patients in the United States. Clin J Am Soc Nephrol 4:1363–1369PubMedPubMedCentralGoogle Scholar
  11. Chobanian AV, Bakris GL, Black HR et al (2003) Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure; National Heart, Lung and Blood Institute; National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Hypertension 42:1206–1252Google Scholar
  12. Cogan MG (1990) Angiotensin II: a powerful controller of sodium transport in the early proximal tubule. Hypertension 15:451–458PubMedGoogle Scholar
  13. Converse RL, Jacobsen TN, Toto RD et al (1992) Sympathetic overactivity in patients with chronic renal failure. N Engl J Med 327:1912–1918PubMedGoogle Scholar
  14. Daniels SR, Loggie JM, Khoury P et al (1998) Left ventricular geometry and severe left ventricular hypertrophy in children and adolescents with essential hypertension. Circulation 97:1907–1911PubMedGoogle Scholar
  15. de Borst MH, Vervloet MG, ter Wee PM et al (2011) Cross talk between the renin-angiotensin-aldosterone system and vitamin D-FGF-23-klotho in chronic kidney disease. J Am Soc Nephrol 22:1603–1609PubMedPubMedCentralGoogle Scholar
  16. Dhaun N, Goddard J, Webb DJ (2006) The endothelin system and its antagonism in chronic kidney disease. J Am Soc Nephrol 17:943–955PubMedGoogle Scholar
  17. DiBona GF (2003) Neural control of the kidney: past, present and future. Hypertension 41:621–624PubMedPubMedCentralGoogle Scholar
  18. Din-Dzietham R, Liu Y, Bielo MV et al (2007) High blood pressure trends in children and adolescents in national surveys, 1963 to 2002. Circulation 116:1488–1496Google Scholar
  19. Fardet L, Feve B (2014) Systemic glucocorticoid therapy: a review of its metabolic and cardiovascular adverse events. Drugs 74:1731–1745PubMedGoogle Scholar
  20. Fathallah-Shaykh SA, Flynn JT, Pierce CB et al (2015) Progression of pediatric CKD of nonglomerular origin in the CKiD cohort. Clin J Am Soc Nephrol 10:571–577PubMedPubMedCentralGoogle Scholar
  21. Fedecostante M, Spannella F, Cola G et al (2014) Chronic kidney disease is characterized by “double trouble” higher pulse pressure plus night-time systolic blood pressure and more severe cardiac damage. PLoS One 9(1):e86155PubMedPubMedCentralGoogle Scholar
  22. Ferguson M, Flynn JT (2014) Rational use of antihypertensive medications in children. Pediatr Nephrol 29:979–988PubMedGoogle Scholar
  23. Flynn JT (2011) Ambulatory blood pressure monitoring in children: imperfect yet essential. Pediatr Nephrol 26:2089–2094PubMedGoogle Scholar
  24. Flynn JT, Kaelber DC, Baker-Smith CM et al (2017) Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 2017;140(3):e20171904Google Scholar
  25. Flynn JT, Mitsnefes M, Pierce C et al (2008) Blood pressure in children with chronic kidney disease. Hypertension 52:631–637PubMedPubMedCentralGoogle Scholar
  26. Flynn JT, Pierce CB, Miller ER et al (2012) Reliability of resting blood pressure measurement and classification using an oscillometric device in children with chronic kidney disease. J Pediatr 160:434–440PubMedGoogle Scholar
  27. Flynn JT, Daniels SR, Hayman LL et al (2014) Update: ambulatory blood pressure monitoring in children and adolescents: a scientific statement from the American Heart Association. Hypertension 63:1116–11352PubMedPubMedCentralGoogle Scholar
  28. Foster BJ, Khoury PR, Kimball TR et al (2016) New reference centiles for left ventricular mass relative to lean body mass in children. J Am Soc Echocardiogr 29:441–447PubMedGoogle Scholar
  29. Fukuta H, Hayano J, Ishihara S et al (2003) Prognostic value of heart rate variability in patients with end-stage renal disease on chronic haemodialysis. Nephrol Dial Transplant 18:318–325PubMedGoogle Scholar
  30. Furusawa EA, Filho UD, Koch VH (2009) Home blood pressure monitoring in paediatric chronic hypertension. J Hum Hypertens 23:464–469PubMedGoogle Scholar
  31. Gabbai FB, Rahman M, Hu B et al (2012) Relationship between ambulatory BP and clinical outcomes in patients with hypertensive CKD. Clin J Am Soc Nephrol 7:1770–1776PubMedPubMedCentralGoogle Scholar
  32. Gartenmann AC, Fossali E, von Vigier RO et al (2003) Better renoprotective effect of angiotensin II antagonist compared to dihydropyridine calcium channel blocker in childhood. Kidney Int 64:1450–1454PubMedGoogle Scholar
  33. Gomez-Marin O, Prineas RJ, Rastam L (1992) Cuff bladder width and blood pressure measurement in children and adolescents. J Hypertens 10:1235–1241PubMedGoogle Scholar
  34. Gorostidi M, Sarafidis PA, de la Sierra A et al (2013) Differences between office and 24-hour blood pressure control in hypertensive patients with CKD: a 5693-patient cross-sectional analysis from Spain. Am J Kidney Dis 62:285–294PubMedGoogle Scholar
  35. Gorostidi M, Sarafidis P, Sierra Ade L et al (2015) Blood pressure variability increases with advancing chronic kidney disease stage (abstract). A cross-sectional analysis of 14,382 hypertensive patients from Spain. J Hypertens 33(Suppl 1):e40Google Scholar
  36. Grassi G, Quarti-Trevano F, Seravalle G (2011) Early sympathetic activation in the initial clinical stages of chronic renal failure. Hypertension 57:846–851PubMedGoogle Scholar
  37. Grassi G, Bertoli S, Seravalle G (2012) Sympathetic nervous system: role in hypertension and chronic kidney disease. Curr Opin Nephrol Hypertens 21:46–51PubMedGoogle Scholar
  38. Gulhan B, Topaloglu R, Karabulut E et al (2014) Post-transplant hypertension in pediatric kidney transplant recipients. Pediatr Nephrol 29:1075–1080PubMedGoogle Scholar
  39. Halbach SM, Martz K, Mattoo T et al (2012) Predictors of blood pressure and its control in pediatric patients receiving dialysis. J Pediatr 160:621–625PubMedGoogle Scholar
  40. Hanevold C, Waller J, Daniels S et al (2004) The effects of obesity, gender and ethnic group on left ventricular hypertrophy and geometry in hypertensive children: a collaborative study of the International Pediatric Hypertension Association. Pediatrics 113:328–333Google Scholar
  41. Harel Z, Gilbert C, Wald R et al (2012) The effect of combination treatment with aliskiren and blockers of the renin-angiotensin system on hyperkalemia and acute kidney injury: systematic review and meta-analysis. BMJ 344:e42PubMedPubMedCentralGoogle Scholar
  42. Hermida RC, Ayala DE, Mojon A et al (2011) Bedtime dosing of antihypertensive medications reduces cardiovascular risk in CKD. J Am Soc Nephrol 22:2313–2321PubMedPubMedCentralGoogle Scholar
  43. Holliday MA, Egan TJ, Morris CR et al (1967) Pitressin-resistant hyposthenuria in chronic renal disease. Am J Med 42:378–387PubMedGoogle Scholar
  44. Hooper SR, Gerson AC, Butler RW et al (2011) Neurocognitive functioning of children and adolescents with mild-to-moderate chronic kidney disease. Clin J Am Soc Nephrol 6:1824–1830PubMedPubMedCentralGoogle Scholar
  45. Horne EJ, Walsh SB, McCormick JA et al (2012) Pathogenesis of calcineurin inhibitor-induced hypertension. J Nephrol 25:269–275Google Scholar
  46. Ibrahim HN, Hostetter TH (1998) The renin-aldosterone axis in two models of reduced renal mass in the rat. J Am Soc Nephrol 9:72–76PubMedGoogle Scholar
  47. Johnstone LM, Jones CL, Grigg LE et al (1996) Left ventricular abnormalities in children, adolescents and young adults with renal disease. Kidney Int 50:998–1006PubMedGoogle Scholar
  48. Kavey RW, Allade V, Daniels SR et al (2006) Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association Expert Panel on Population and Prevention Science: The Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research: Endorsed by the American Academy of Pediatrics. Circulation 114:2710–2738PubMedGoogle Scholar
  49. Khoury PR, Mitsnefes M, Daniels SR et al (2009) Age-specific reference intervals for indexed left ventricular mass in children. J Am Soc Echocardiogr 22:709–714PubMedGoogle Scholar
  50. Klag MJ, Whelton PK, Randall BL et al (1996) Blood pressure and end-stage renal disease in men. N Engl J Med 34:13–18Google Scholar
  51. Kobori H, Nangaku M, Navar G et al (2007) The intrarenal renin-angiotensin system: from physiology to the pathobiology of hypertension and kidney disease. Pharmacol Rev 59:251–287Google Scholar
  52. Kogon AJ, Pierce CB, Cox C et al (2014) Nephrotic-range proteinuria is strongly associated with poor blood pressure control in pediatric chronic kidney disease. Kidney Int 85:938–944PubMedGoogle Scholar
  53. Koomans HA, Roos JC, Boer P et al (1982) Salt sensitivity of blood pressure in chronic renal failure: evidence for renal control of body fluid distribution in man. Hypertension 4:190–197PubMedGoogle Scholar
  54. Kopp UC, DiBona GF (1993) Neural regulation of renin secretion. Semin Nephrol 13:543–551PubMedGoogle Scholar
  55. Kramer AM, van Stralen KJ, Jager KJ et al (2011) Demographics of blood pressure and hypertension in children on renal replacement therapy in Europe. Kidney Int 80:1092–1098PubMedGoogle Scholar
  56. Ksiazek A, Klosowska J, Sygulla K et al (2013) Arterial hypertension and progression of chronic kidney disease in children during 10-year ambulatory observation. Clin Exp Hypertens 35:424–429PubMedGoogle Scholar
  57. Kupferman JC, Friedman LA, Cox C et al (2014) BP control and left ventricular hypertrophy regression in children with CKD. J Am Soc Nephrol 25:167–174PubMedGoogle Scholar
  58. Lande MB, Kaczorowski JM, Auinger P et al (2003) Elevated blood pressure and decreased cognitive function among school-age children and adolescents in the United States. J Pediatr 143:720–724Google Scholar
  59. Lande MB, Adams H, Falkner B et al (2009) Parental assessments of internalizing and externalizing behavior and executive function in children with primary hypertension. J Pediatr 154:207–212Google Scholar
  60. Lande MB, Adams H, Falkner B et al (2010) Parental assessment of executive function and internalizing and externalizing behavior in primary hypertension after anti-hypertensive therapy. J Pediatr 157:114–119PubMedPubMedCentralGoogle Scholar
  61. Lande MB, Gerson AC, Hooper SR et al (2011) Casual blood pressure and neurocognitive function in children with chronic kidney disease: a report of the children with chronic kidney disease cohort study. Clin J Am Soc Nephrol 6:1831–1837PubMedPubMedCentralGoogle Scholar
  62. Lande MB, Mendley SR, Matheson MB et al (2016) Association of blood pressure variability and neurocognition in children with chronic kidney disease. Pediatr Nephrol 31:2137–2144PubMedPubMedCentralGoogle Scholar
  63. Ligtenberg G, Blankenstin PJ, Oey PL et al (1999) Reduction of sympathetic hyperactivity by enalapril in patients with chronic renal failure. N Engl J Med 340:1321–1328PubMedGoogle Scholar
  64. Lin YJ, Hsu CN, Lo MH et al (2013) High citrulline-to-arginine ratio associated with blood pressure abnormalities in children with early chronic kidney disease. Circ J 77:181–187PubMedGoogle Scholar
  65. Lindblad YT, Axelsson J, Balzano R et al (2013) Left ventricular diastolic dysfunction by tissue Doppler echocardiography in pediatric chronic kidney disease. Pediatr Nephrol 28:2003–2013PubMedGoogle Scholar
  66. Litwin M, Wuhl E, Jourdan C et al (2008) Evolution of large-vessel arteriopathy in paediatric patients with chronic kidney disease. Nephrol Dial Transplant 23:2552–2557PubMedGoogle Scholar
  67. Liu X, Liu X, Huang W et al (2014) Evening- versus morning-dosing drug therapy for chronic kidney disease patients with hypertension: a systematic review. Kidney Blood Press Res 39:427–440PubMedGoogle Scholar
  68. Lurbe E, Cifkova R, Cruickshank JK et al (2009) Management of high blood pressure in children and adolescents: recommendations of the European Society of Hypertension. J Hypertens 27:1719–1742PubMedGoogle Scholar
  69. Lurbe E, Agabiti-Rosei E, Cruickshank JK et al (2016) 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens 34:1887–1920Google Scholar
  70. Matteucci MC, Wuhl E, Picca S et al (2006) Left ventricular geometry in children with mild to moderate chronic renal insufficiency. J Am Soc Nephrol 17:218–226PubMedGoogle Scholar
  71. Matteucci MC, Chinali M, Rinelli G et al (2013) Change in cardiac geometry and function in CKD children during strict BP control: a randomized study. Clin J Am Soc Nephrol 8:203–210PubMedGoogle Scholar
  72. McGlothan KR, Wyatt RJ, Ault BH et al (2006) Predominance of nocturnal hypertension in pediatric renal allograft recipients. Pediatr Transplant 10:558–564PubMedGoogle Scholar
  73. McNiece KL, Poffenbarger TS, Turner JL et al (2007) Prevalence of hypertension and pre-hypertension among adolescents. J Pediatr 150:640–644PubMedPubMedCentralGoogle Scholar
  74. Mitsnefes M, Ho P-L, McEnery PT (2003) Hypertension and progression of chronic renal insufficiency in children: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). J Am Soc Nephrol 14:2618–2622PubMedGoogle Scholar
  75. Mitsnefes MM, Kimball TR, Kartal J et al (2005) Cardiac and vascular adaptation in pediatric patients with chronic kidney disease: role of calcium-phosphorus metabolism. J Am Soc Nephrol 16:2796–2803PubMedGoogle Scholar
  76. Mitsnefes M, Flynn J, Cohn S et al (2010) Masked hypertension associates with left ventricular hypertrophy in children with CKD. Clin J Am Soc Nephrol 21:137–144Google Scholar
  77. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576Google Scholar
  78. National Kidney Foundation (2004) KDOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis 43:S1–S290Google Scholar
  79. Noone DG, Marks SD (2013) Hyperuricemia is associated with hypertension, obesity and albuminuria in children with chronic kidney disease. J Pediatr 162:128–132PubMedGoogle Scholar
  80. Parekh RRS, Flynn JT, Smoyer WE et al (2001) Improved growth in young children with severe chronic renal insufficiency who use specified nutritional therapy. J Am Soc Nephrol 12:2418–2426PubMedGoogle Scholar
  81. Parekh RS, Carroll CE, Wolfe RA et al (2002) Cardiovascular mortality in children and young adults with end-stage kidney disease. J Pediatr 141:191–197PubMedGoogle Scholar
  82. Park MK, Menard SW, Yuan C (2001) Comparison of auscultatory and oscillometric blood pressures. Arch Pediatr Adolesc Med 155:50–53PubMedGoogle Scholar
  83. Peterson JC, Adler S, Burkart JM et al (1995) Blood pressure control, proteinuria, and the progression of renal disease. The Modification of Diet in Renal Disease Study. Ann Intern Med 123:754–762PubMedGoogle Scholar
  84. Portale AA, Wolf M, Juppner H et al (2014) Disordered FGF23 and mineral metabolism in children with CKD. Clin J Am Soc Nephrol 9:344–353PubMedGoogle Scholar
  85. Prospective Studies Collaboration (2002) Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 360:1913–1920Google Scholar
  86. Reddy YS, Kiranmayi VS, Bitla AR et al (2015) Nitric oxide status in patients with chronic kidney disease. Indian J Nephrol 25:287–291PubMedPubMedCentralGoogle Scholar
  87. Rhaleb NE, Yang XP, Carretero OA (2011) The Kallikrein-kinin system as a regulator of cardiovascular and renal function. Compr Physiol 1:971–993PubMedPubMedCentralGoogle Scholar
  88. Robles NR, Fici F, Grassi G (2016) Dihydropyridine calcium channel blockers and renal disease. Hypertens ResGoogle Scholar
  89. Rodenbach KE, Schneider MF, Furth SL et al (2015) Hyperuricemia and progression of CKD in children: the Chronic Kidney Disease in Children (CKiD) cohort study. Am J Kidney Dis 66:984–992PubMedPubMedCentralGoogle Scholar
  90. Rubinger D, Backenroth R, Sapoznikov D (2013) Sympathetic nervous system function and dysfunction in chronic hemodialysis patients. Semin Dial 26:333–343PubMedGoogle Scholar
  91. Salgado CM, Jardim PC, Viana JK et al (2011) Home blood pressure in children and adolescents: a comparison with office and ambulatory blood pressure measurements. Acta Paediatr 100:e163–e168PubMedGoogle Scholar
  92. Samuels J, Ng D, Flynn JT et al (2012) Ambulatory blood pressure patterns in children with chronic kidney disease. Hypertension 60:43–50PubMedPubMedCentralGoogle Scholar
  93. Sasaki N, Ando Y, Kusano E et al (2003) A case of erythropoietin induced hypertension in a bilaterally nephrectomized patient. ASAIO J 49:131–135PubMedGoogle Scholar
  94. Seeman T, Simkova E, Kreisinger J et al (2006) Control of hypertension in children after renal transplant. Pediatr Transplant 10:316–322PubMedGoogle Scholar
  95. Shroff R, Degi A, Kerti A et al (2013) Cardiovascular risk assessment in children with chronic kidney disease. Pediatr Nephrol 28:875–884PubMedGoogle Scholar
  96. Simpson JM, Savis A, Rawlins D et al (2010) Incidence of left ventricular hypertrophy in children with kidney disease: impact of method of indexation of left ventricular mass. Eur J Echocardiogr 11:271–277PubMedGoogle Scholar
  97. Sinha MD, Tibby SM, Rasmussen P et al (2011) Blood pressure control and left ventricular mass in children with chronic kidney disease. Clin J Am Soc Nephrol 6:543–551PubMedPubMedCentralGoogle Scholar
  98. Sinha MD, Kerecuk L, Gilg J et al (2012) Systemic arterial hypertension in children following renal transplantation: prevalence and risk factors. Nephrol Dial Transplant 27:3359–3368PubMedGoogle Scholar
  99. Soergel M, Kirschstein M, Busch C et al (1997) Oscillometric twenty-four-hour ambulatory blood pressure values in children and adolescents: a multicenter trial including 1141 subjects. J Pediatr 130:178–184PubMedGoogle Scholar
  100. Sorof JM, Sullivan EK, Tejani A et al (1999) Antihypertensive mediation and renal allograft failure: a North American Renal Transplant Cooperative Study report. J Am Soc Nephrol 10:1324–1330PubMedGoogle Scholar
  101. Staples AO, Greenbaum LA, Smith JM et al (2010) Association between clinical risk factors and progression of chronic kidney disease in children. Clin J Am Soc Nephrol 5:2172–2179PubMedPubMedCentralGoogle Scholar
  102. Stergiou GS, Karpettas N, Kapoyiannis A et al (2009) Home blood pressure monitoring in children and adolescents: a systematic review. J Hypertens 27:1941–1947PubMedGoogle Scholar
  103. Stergiou GS, Ntineri A, Kollias A et al (2015) Changing relationship among clinic, home and ambulatory blood pressure with increasing age. J Am Soc Hypertens 9:544–552PubMedGoogle Scholar
  104. Sullivan JE, Keefe D, Zhou Y et al (2013) Pharmacokinetics, safety profile, and efficacy of aliskiren in pediatric patients with hypertension. Clin Pediatr 52:599–607Google Scholar
  105. Tanner RM, Shimbo D, Dreisbach AW et al (2015) Association between 24-hour blood pressure variability and chronic kidney disease: a cross-sectional analysis of African Americans participating in the Jackson heart study. BMC Nephrol 16:84PubMedPubMedCentralGoogle Scholar
  106. The ESCAPE Trial Group (2009) Strict blood-pressure control and progression of renal failure in children. N Engl J Med 361:1639–1650Google Scholar
  107. The ONTARGET Investigators (2008) Telmisartan, ramipril or both in patients at high risk for vascular events. N Engl J Med 358:1547–1559Google Scholar
  108. Townsend RR, Tomiyama H (2013) Arterial stiffness, kidney function and chronic kidney disease progression. Pulse 1:123–130PubMedPubMedCentralGoogle Scholar
  109. United States Renal Data System (2015) 2015 USRDS annual data report: epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Available at Accessed 1 Sept 2016Google Scholar
  110. Urbina EM (2016) Abnormalities of vascular structure and function in pediatric hypertension. Pediatr Nephrol 31:1061–1070PubMedGoogle Scholar
  111. Vaziri ND (1999) Mechanism of erythropoietin-induced hypertension. Am J Kidney Dis 33:821–828PubMedGoogle Scholar
  112. Vervloet MG, Adema AY, Larsson TE et al (2014) The role of klotho in vascular calcification and endothelial function in chronic kidney disease. Semin Nephrol 34:578–585PubMedGoogle Scholar
  113. Vink EE, Blankestijn PJ (2012) Evidence and consequences of the central role of the kidneys in the pathophysiology of sympathetic hyperactivity. Front PhysiolGoogle Scholar
  114. Wang J, Qin T, Chen J et al (2014) Hyperuricemia and risk of incident hypertension: a systematic review and meta-analysis of observational studies. PLoS OneGoogle Scholar
  115. Warady BA, Abraham AG, Schwartz GJ et al (2015) Predictors of rapid progression of glomerular and nonglomerular kidney disease in children and adolescents: the Chronic Kidney Disease in Children (CKiD) cohort. Am J Kidney Dis 65:878–888PubMedPubMedCentralGoogle Scholar
  116. Warren TJ, Ferris TF (1970) Renin secretion in renal hypertension. Lancet 1:159–162PubMedGoogle Scholar
  117. Wilson AC, Schneider MF, Cox C et al (2011) Prevalence and correlates of multiple cardiovascular risk factors in children with chronic kidney disease. Clin J Am Soc Nephrol 6:2759–2765PubMedPubMedCentralGoogle Scholar
  118. Wingen AM, Fabian-Bach C, Schaefer F et al (1997) Randomized multi-centre study of a low-protein diet on the progression of chronic renal failure in children. Lancet 349:1117–1123PubMedGoogle Scholar
  119. Woroniecki RP, Flynn JT (2005) How are hypertensive children evaluated and managed? A survey of North American pediatric nephrologists. Pediatr Nephrol 20:791–797PubMedGoogle Scholar
  120. Wright JT Jr, Bakris G, Greene T et al (2003) African American study of kidney disease and hypertension: effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA 288:2421–2431Google Scholar
  121. Wuhl E, Witte K, Soergel M et al (2002) German Working Group on Pediatric Hypertension. Distribution of 24-h ambulatory blood pressure in children: normalized reference values and role of body dimensions. J Hypertens 20:1995–2007Google Scholar
  122. Wuhl E, Hadtstein C, Mehls O et al (2004) Home, clinic and ambulatory blood pressure monitoring in children with chronic renal failure. Pediatr Res 55:492–497PubMedGoogle Scholar
  123. Yang Q, Zhong Y, Merritt R et al (2016) Trends in high blood pressure among United States adolescents across body weight category between 1988 and 2012. J Pediatr 169:166–173Google Scholar
  124. Yano Y, Bakris GL, Matsushita K et al (2013) Both chronic kidney disease and nocturnal blood pressure associate with strokes in elderly. Am J Nephrol 38:195–203PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Division of Nephrology, Seattle Children’s HospitalUniversity of Washington School of MedicineSeattleUSA

Section editors and affiliations

  • Joseph T. Flynn
    • 1
    • 2
  1. 1.Division of NephrologySeattle Children’s HospitalSeattleUSA
  2. 2.Department of PediatricsUniversity of Washington School of MedicineSeattleUSA

Personalised recommendations