Hypertension in children and adolescents with chronic renal failure and end-stage renal disease.

The incidence of hypertension (HT) in renal parenchymal disease of the young is very high, varying from 38 to 78%. This points to the central role of the kidneys in normal blood pressure control. HT in chronic renal failure (CRF) and end-stage renal disease (ESRD) depends on the nature of the underlying disease. The degree of renal failure has a highly variable effect. The clinical signs and symptoms of this form of HT are often superimposed on those of the basic (renal) disorder. The pathogenesis of HT in CRF is dominated by volume- and renin-mediated mechanisms. In addition, a wide variety of humoral and neural factors play a role. The HT seen in patients on renal replacement therapy (RRT) and after renal transplantation (Tx) poses special problems. In this paper these various aspects of HT in CRF are discussed and the principles of treatment are reviewed. It has been shown beyond any doubt that control of HT in young patients with CRF and ESRD, treated conservatively or on RRT and after renal Tx is of utmost importance for their long-term outcome. This is an important challenge for all pediatricians looking after young patients with CRF and ESRD.