ArticlePediatric nephrology (Berlin, Germany)2025
Investigations for diagnosis of secondary hypertension in children: yield and costs.
Article in Pediatric nephrology (Berlin, Germany), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Prevalence and risk factors for acute kidney injury at the diagnosis of juvenile idiopathic arthritis in children and its long-term implications for kidney health.Pediatric nephrology (Berlin, Germany) · 2026Article
- Hypertension in middle childhood.BMC pediatrics · 2026Article
- Kidney injury risk in congenital solitary functioning kidney: the role of nephron mass assessed by serum uromodulin and the rs4293393 T > C polymorphism.BMC research notes · 2025Article
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Authors and funding
9 authors.
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Abstract
backgroundScreening for secondary hypertension is not recommended for all hypertensive patients, but missing these cases is critical. We aimed to (i) assess hypertension causes in a cohort of hypertensive children, (ii) determine the costs and contributions of an extended diagnostic work-up to screen for secondary hypertension, and (iii) compare the performance of a "short diagnostic work-up" with the protocols of the American Academy of Pediatrics (AAP) and European Society of Hypertension (ESH).
methodsWe conducted a retrospective, single-center study of 70 hypertensive patients aged 1-18 years. All underwent an extended work-up to exclude secondary hypertension. Diagnostic findings, test counts, and costs were analyzed. A short work-up (serum creatinine, fasting glucose, electrolytes, urinalysis, kidney ultrasound (US), and renal artery Doppler US), as well as the AAP and ESH protocols, was evaluated for performance and costs.
resultsSecondary hypertension was identified in 29 patients (41.4%). The extended protocol identified or excluded secondary causes in all patients. Kidney US had the highest diagnostic yield (37.1%). The short work-up and ESH protocol identified all secondary cases, whereas the AAP protocol missed 15 diagnoses. The extended protocol cost € 17,715.60 (€ 253.08 per patient). Direct cost savings were 64.3% with the short work-up, 92.4% with the AAP protocol, and 76.2% with the ESH protocol.
conclusionsPrimary is more common than secondary hypertension in children, with kidney parenchymal disease being the leading secondary cause. As recommended by guidelines, a simplified, focused work-up may offer a cost-effective alternative to extensive screening while maintaining diagnostic accuracy.
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