Hypertension in 2-yr-old

[LaurieG]

During our last round of specialist visits in Oct DD's BP was very high at both her Endo and Neph visits. The Neph asked me to check it at home twice weekly and fax in the results after a month. She also said that (I think due to her kidney issues - prenatal hydronephrosis, congenital multicystic dysplastic non-functioning kidney, congential dual drainage system in the other kidney, renal tubular acidosis) we will want to keep her BP in the 50th % range for her gender, age, and height rather than the typical recommendation of 90th%.

So I've now been checking it for more than 2 months and sent 2 faxes with the only response being via our general pedi who reported back that in a conversation with the neph the neph said she was comfortable with DD's BP's. This surprised me since her BP is nearly always in the 90th - 99th% even when she is sleeping. For now I've been leaving it alone because I didn't want to influence the doc into a more aggressive treatment than she was inclined to recommend. But, although I really like the neph, communication between visits is terrible. The nurses seem to have a really hard time getting answers back and inevitably the the question gets changed in the process so by the time I get an answer weeks later it isn't even to the question I asked. We don't have an appt until April.

Lately I've been doing some research and now I'm alarmed. What I'm reading supports bringing down the BP as quickly as possible. One thing said secondary hypertension (which is what I assume we're dealing with since DD is only 2 and anything but obese at 21 lbs) should always be treated. I'm curious what has been other mom's experience - do the docs treat to 50th %, or 90th%, or something else? I'm also wondering what kind of testing is done to determine the cause? I worry about the side effects of BP meds, especially since DD is so young. But then again, I also worry about damage to her heart and kidney from going untreated for many months. I'm considering changing my "wait and see" policy to one asking the Neph to deal with this before April. Thoughts on that? DD has been through so much medically and has always had a lot of anxiety around medical stuff that I try to limit it as much as I feel is safe. So anyway, lots of considerations running through my head and I would love to get some thoughts/ perspective / info.

TIA!

[LaurieG]

I forgot to mention I'm also wondering whether there are things I could do nutritionally or with supplementation that might help.

[LaurieG]

Bumping

Anyone with a kiddo with secondary hypertension?

[workjw]

I don't have any experience with hypertension really, but thought I would share our experience. DD had some high bp readings in a row for a number of months earlier this year. Our uro was concerned about it and sent us to see nephro (who we only see when needed). They did a number of readings throughout the day, her bp was in the 95% or higher half of the time, and 75% or so the other half. After that we did bi-weekly readings, which were sometimes normal and sometimes in the 90% + range (sometimes off the chart). After reading online, I was very concerned, but our doctor's weren't really. After our second nephro appt, she explained that bp was really hard to read accurately in children 2 and under (dd was 27 months at the time) and that unless it went up and stayed up all the time, that she wasn't too concerned about it considering her kidneys were looking so good right now. She said in kids this age she doesn't usually treat unless it remains over 99% for an extended period. Eventually dd's bp went down, and her readings are normally in the 75% range now. Don't have any idea why she had all the high readings for the 6 months or so.

Don't know if any of that is at all helpful, but just thought I would share since no one else has responded yet. If you are really worried about it, I would just set up an appt with nephro and see if they can give you some better information. I hope you find some answers soon!

[LaurieG]

Originally Posted by workjw

I don't have any experience with hypertension really, but thought I would share our experience. DD had some high bp readings in a row for a number of months earlier this year. Our uro was concerned about it and sent us to see nephro (who we only see when needed). They did a number of readings throughout the day, her bp was in the 95% or higher half of the time, and 75% or so the other half. After that we did bi-weekly readings, which were sometimes normal and sometimes in the 90% + range (sometimes off the chart). After reading online, I was very concerned, but our doctor's weren't really. After our second nephro appt, she explained that bp was really hard to read accurately in children 2 and under (dd was 27 months at the time) and that unless it went up and stayed up all the time, that she wasn't too concerned about it considering her kidneys were looking so good right now. She said in kids this age she doesn't usually treat unless it remains over 99% for an extended period. Eventually dd's bp went down, and her readings are normally in the 75% range now. Don't have any idea why she had all the high readings for the 6 months or so.

Don't know if any of that is at all helpful, but just thought I would share since no one else has responded yet. If you are really worried about it, I would just set up an appt with nephro and see if they can give you some better information. I hope you find some answers soon!

Thanks for responding. This is reassuring. Hopefully DD's BP will go down on its own I don't want to put her through a bunch of testing if its not needed.

[Jessmomto2]

Coming from the mom of a child whose 2 year old recently had a kidney transplant, I would keep calling until you can get the nurse to pass on to the dr that you would like to speak with them personally. Or ask if you can make a sooner appt. I would be curious what your dd's creatinine level is. If it was normal, I probably wouldn't be as worried as that should mean that the BP levels weren't damaging the kidney. But, I would definitely keep pestering them until you get the answers you need.

[LaurieG]

Originally Posted by Jessmomto2

Coming from the mom of a child whose 2 year old recently had a kidney transplant, I would keep calling until you can get the nurse to pass on to the dr that you would like to speak with them personally. Or ask if you can make a sooner appt. I would be curious what your dd's creatinine level is. If it was normal, I probably wouldn't be as worried as that should mean that the BP levels weren't damaging the kidney. But, I would definitely keep pestering them until you get the answers you need.

Thanks for posting this. Your post motivated me to make another call and at least now I think I understand what the nephrologist is thinking, although I don't agree.

She wants us to keep checking DD every week or so, preferrably in her sleep. She thinks DD's BP is still related to anxiety from the procedure and not due to her kidney. I think they checked the creatinine last visit but I'm not sure about that. In any case, the last time it was checked it was normal.

I'm personally thinking the elevated BP is due to her snoring and possible sleep apnea. I'm not sure where to go with that idea so I guess I'll bring it up with the Endocrinologist next week and see her thoughts.

I hope your dd is recovering quickly and getting back to the joys of being 2.

[Jessmomto2]

Thank you! Glad I could help in any way. If you ever need any kidney related questions answered, I'm fairly knowledgeable on the kidney at this point. My ds is doing fairly well. He has a cold right now but his immune system seems to be slowly tackling it.