Diagnostic Dilemma - Pediatric Oncall
Transient Hypertension with Hypertensive emergency in
Author: Jyoti Sharma
A 15 year old adolescent presented with history of generalized swelling, which started with periorbital puffiness that progressed cephalocaudaly and hematuria for 5 days prior to admission.He had no prior history of sore throat pyoderma, headache, blurring of vision or altered sensorium. On examination he had facial puffiness, pedal and abdominal wall edema.His Blood Pressure was 170, 100,plus, - 10 mm of Hg in three readings over 1st two hours of admission.{stage 2 hypertension for his age,sex and height} Fundus examination was normal.On blood analysis his serum urea and
creatinine were 85 mg percent and 1.1mg percent{ More than 1mg percent} respectively. Serum electrolytes, serum
proteins and lipid profile were within normal limits.Antisreptococcal antibody titre was
raised markedly and serum C3 level was drastically reduced. On urinalysis,RBC count
was 250, ml,proteins 4plus and leucocytes 100, ml.Ultrasonography of abdomen revealed
increased cortical echo texture of both the kidneys suggesting medical renal disease. In view of above evidence diagnosis of post-streptococcal glomerulonephritis was made. In relation to this I have the following queries to make:-
1} As this adolescent is having transient stage 2 Hypertension and renal dysfunction which is present in majority of PSGN patients, shall we categorise him to the hypertensive emergency as mentioned by Bagga el,a l{1} or hypertensive urgency.
2}If it is to be categorized as hypepertensive emergency,shall we treat this with calcium
channel blockers and frusemide or aggressively in PICU with intravenous antihypertensive drugs i.e. Sodium nitroprusside or labetalol under constant

1}Bagga A, Jain R, Vijayakumar M, Kanitkar M, Ali U. Evaluation and management of
hypertension. Indian Pediatr.2007`44:103-21.
2}S Dinesh,A Olugbenga,Y Ihor,E Samer.Emergency management of Hypertension in
children.Int J Nephr 2012`10:1155-70

Answers of this discussion
Author :- sarah Ashour on 23 March 2013.
Answer :- urgency hypertension treated in ICU with IV sodium nitroprusside or labetaloi under moniter

Author :- Vikalp Shastri on 04 April 2013.
Answer :- calcium channel blockers and frusemide

Author :- Doctor Kamboh on 04 April 2013.
Answer :- In my opinion as the patient is having stage II hypertension, along with acute renal failure, he should be managed using hypertension emergency management protocol in ICU using iv labetalol with 1, 3 rd of BP reduction in first 6 hrs and the rest in next 48 to 72 hrs

Author :- Kamiludeen Hassan on 04 April 2013.
Answer :- hypertensive emergency as there sign of end organ damage.shd be treated with iv labetalol with close monitoring

Author :- vinod sharma on 05 April 2013.
Answer :- As urgency, in PICU with i.v nitroprusside and labetalol

Author :- Ghavate Vikram on 05 April 2013.
Answer :- fluid restriction and diuretics only!

Author :- Niyaz Ahmad Buch on 07 April 2013.
Answer :- calcium chhanel blockers with frusemide

Author :- Dr. Rama Diab on 17 April 2013.
Answer :- urgency hypertension treated in icu with sodium nitroprusside or labtelol under montering

Author :- Rolando Lezama on 24 April 2013.
Answer :- Calcium channel blocker and Furosemide

Author :- TAUQIR KHAN on 28 April 2013.
Answer :- urgency hypertension treated with frusemide and ca channel blockers.

Disclaimer: The information given by www.pediatriconcall.com is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.