Question

A seven year old asymptomatic girl is found to have persistent hypertension. There is no significant history and urine examination is normal. Which of the following is the most likely cause?

• A. Essential hypertension
• B. Renal parenchymal disease
• C. Polycystic kidney disease
• D. Coarctation of aorta

Hint:

In young children most hypertension is secondary, and the commonest group is renal.

Answer 1

The Correct Option is B

Step 1: In children, unlike adults, hypertension is usually secondary, meaning it has an underlying cause. The younger the child and the higher the blood pressure, the more likely there is a secondary cause.
Step 2: The single most common cause of secondary hypertension in children is renal disease. Of the renal causes, renal parenchymal disease (such as chronic glomerulonephritis, reflux nephropathy or scarring) is the leading group, followed by renovascular disease.
Step 3: The normal urine examination does not rule out renal parenchymal disease, because scarred or chronically damaged kidneys can have bland urine. So this choice still fits best.
Step 4: Why the others are less likely. Essential hypertension is the rule in adults and adolescents but is uncommon at age seven. Polycystic kidney disease is one specific cause but is far less common than parenchymal disease as a group and often gives a palpable mass or family history. Coarctation of the aorta would usually show a blood pressure difference between arms and legs with weak femoral pulses, none of which is described.
Step 5: The most likely cause is renal parenchymal disease.
Answer: Option B, Renal parenchymal disease.