Chapter 6: Blood pressure management in children with CKD ND

doi:10.1038/kisup.2012.56

Cited by 14 publications

(1 citation statement)

References 49 publications

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“…Antihypertensive and antiproteinuric treatment have the dual aims of lowering cardiovascular mortality and preserving kidney function, because blood pressure is one of the important modifiable risk factors. There are universal recommendations to lower blood pressure in children with hypertension and especially children with CKD [80][81][82][83] with a host of evidence, but we will focus on reviewing ADPKD-specific evidence here.…”

Section: Antihypertensive and Antiproteinuric Treatmentmentioning

confidence: 99%

The wind of change in the management of autosomal dominant polycystic kidney disease in childhood

2021

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Significant progress has been made in understanding the genetic basis of autosomal dominant polycystic kidney disease (ADPKD), quantifying disease manifestations in children, exploring very-early onset ADPKD as well as pharmacological delay of disease progression in adults. At least 20% of children with ADPKD have relevant, yet mainly asymptomatic disease manifestations such as hypertension or proteinuria (in line with findings in adults with ADPKD, where hypertension and cardiovascular damage precede decline in kidney function). We propose an algorithm for work-up and management based on current recommendations that integrates the need to screen regularly for hypertension and proteinuria in offspring of affected parents with different options regarding diagnostic testing, which need to be discussed with the family with regard to ethical and practical aspects. Indications and scope of genetic testing are discussed. Pharmacological management includes renin-angiotensin system blockade as first-line therapy for hypertension and proteinuria. The vasopressin receptor antagonist tolvaptan is licensed for delaying disease progression in adults with ADPKD who are likely to experience kidney failure. A clinical trial in children is currently ongoing; however, valid prediction models to identify children likely to suffer kidney failure are lacking. Non-pharmacological interventions in this population also deserve further study.

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Section: Antihypertensive and Antiproteinuric Treatmentmentioning

confidence: 99%