Abstract:Background: Hypertension is the leading cause of mortality worldwide. Besides its already high disease burden, also the prevalence in children is increasing. Major presentation of hypertension among young patients is as essential or primary hypertension, while only a minority of patients present as secondary hypertension. Characterized by mesangial immune deposits, C1q nephropathy is a relatively rare glomerular disease with a dominant or co-dominant staining for C1q, presenting often with proteinuria in the nephrotic range. Case Report: We present an 18-year-old Turkish boy who presented with hypertension five years ago in the absence of proteinuria followed by a renal biopsy five years later demonstrating dominant mesangial deposits of C1q. Conclusion: We suggest that C1q nephropathy may present with hypertension before the manifestation of proteinuria and thus, C1q nephropathy should be kept in mind in patients presenting with hypertension. More specialized tests should be performed when diagnosing primary hypertension. We suggest that every patient with hypertension should be carefully followed up for C1q nephropathy.