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Blood pressure load, proteinuria and renal function in pre-hypertensive children

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Abstract

It is as yet unclear whether blood pressure load (BPL) can affect renal function in pre-hypertensive children. We have studied 250 children, with a mean age of 9.12 ± 3.28 years, with the aim of assessing if pre-hypertension in children can indeed affect renal function. The study cohort consisted of 146 children with pre-hypertension (group P) and a control group of 104 children with normal blood pressure (group C). All children were tested for orthostatic proteinuria, an exclusion criterion, glomerular filtration rate (GFR), and proteinuria, and ambulatory blood pressure monitoring was performed. Based on the BPL, group P was further subdivided into group P1 (BPL ≤ 40%, low BPL) and group P2 (BPL > 40%, high BPL). We found that GFR was reduced in pre-hypertensive children (90.74 ± 48.69 vs. 110.32 ± 20.30 ml/min per 1.73 m2, p < 0.0001) and that proteinuria was increased (145.36 ± 110.91 vs. 66.84 ± 42.94 mg/m2 per 24 h; p < 0.0001). However, mean values were still within normal limits. A comparison of the group with high BPL and that with low BPL revealed that the former had relatively reduced GFR (79.15 ± 42.04 vs. 96.78 ± 51.20 ml/min per 1.73 m2; p < 0.006) and increased proteinuria (198.29 ± 142.17 vs. 118.31 ± 80.07 mg/m2 per 24 h; p < 0.036). In comparison to the reference values of the normal population, the GFR was reduced and proteinuria was increased in the group with high BPL. Based on our results, pre-hypertension in children with high BPL seems to be associated with reduced GFR and increased proteinuria. A reasonable doubt remains that the patients with higher proteinuria and larger reduction of GFR may harbor an as yet unknown subclinical renal condition responsible for the onset of pre-hypertension. Therefore, children with even mildly elevated BP are at risk of developing renal damage and should change their lifestyle to prevent further increases in BP.

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Authors and Affiliations

  1. Dipartimento di Pediatria, Unità Operativa di Nefrologia Pediatrica, Azienda Policlinico “Umberto I”, Università degli Studi di Roma “La Sapienza”, Viale Regina Elena 324, 00161, Rome, Italy

    Riccardo Lubrano, Elisabetta Travasso, Claudia Raggi & Giuliana Guido

  2. Dipartimento di Medicina Sperimentale e Patologia, Università degli Studi di Roma “La Sapienza”, Viale Regina Elena 324, 00161, Rome, Italia

    Raffaele Masciangelo

  3. Dipartimento di Scienze Cliniche “Osp. Luigi Sacco”, Università degli Studi di Milano, Via G.B. Grassi 74, 20157, Milan, Italia

    Marco Elli

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  1. Riccardo Lubrano
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  2. Elisabetta Travasso
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  5. Raffaele Masciangelo
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Correspondence to Riccardo Lubrano.

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Lubrano, R., Travasso, E., Raggi, C. et al. Blood pressure load, proteinuria and renal function in pre-hypertensive children. Pediatr Nephrol 24, 823–831 (2009). https://doi.org/10.1007/s00467-008-1077-6

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