No abstract

After completing this article, readers should be able to: 1. Understand the distribution of fluid and solute in different body compartments. 2. Demonstrate the homeostatic mechanisms involved in maintaining sodium and water metabolism. 3. Calculate osmolality and recognize the clinical importance of maintaining osmotic equilibrium. 4. Recognize common disorders of hypernatremia or hyperosmolality and evaluate and understand the role of calculating free water deficit in the treatment of these disorders. 5. Recognize common disorders of hyponatremia or hypo-osmolality, appreciate the role of urine sodium and urine osmolality in evaluation,and understand the importance of slow correction of these disorders.

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Despite current guidelines, variability exists in the workup of hypertensive children due to physician preferences. The study evaluates primary vs secondary hypertension diagnosis from investigations routinely performed in hypertensive children. This retrospective study included children 5 to 19 years with primary and secondary hypertension. The proportions of abnormal laboratory and imaging tests were compared between primary and secondary hypertension groups. Risk factors for primary vs secondary hypertension were evaluated by logistic regression and likelihood function analysis. Patients with secondary hypertension were younger (5-12 years) and had a higher proportion of abnormal creatinine, renal ultrasound, and echocardiogram findings. There was no significant difference in abnormal results of thyroid function, urine catecholamines, plasma renin, and aldosterone. Abnormal renal ultrasound findings and age were predictors of secondary hypertension by regression and likelihood function analysis. Children aged 5 to 12 years with abnormal renal ultrasound findings and high diastolic blood pressures are at higher risk for secondary hypertension that requires detailed evaluation. J Clin Hypertens (Greenwich).