From kidneys to cerebral vessels: diverse faces of paediatric hypertensive emergencies

Abstract

Hypertensive emergency in children is rare but potentially life-threatening, requiring urgent recognition and management. Etiologies range from renal to vascular and hematological disorders. We report a descriptive case series of six paediatric patients (ages 1.5-12 years) presenting with acute severe hypertension and target organ damage. Clinical features, underlying causes, diagnostic findings, treatment, and outcomes were analysed.  Six cases were analyzed with mean age 8.5 years and male predominance (4:2). Etiologies included atypical hemolytic uremic syndrome (33%, n=2), chronic kidney disease (17%, n=1), autosomal recessive polycystic kidney disease (17%, n=1), Moyamoya disease with β-thalassemia (17%, n=1), and drug-induced post-bone marrow transplant (17%, n=1). Neurological symptoms occurred in 83% cases, with headache, seizures, and altered sensorium being predominant presentations. All patients presented with blood pressure above 99^th percentile requiring immediate intervention. Treatment included intravenous antihypertensives (labetalol, sodium nitroprusside) combined with etiology-specific therapy including plasmapheresis, hemodialysis, peritoneal dialysis, and immunosuppressive withdrawal. Complete recovery occurred in 50% cases (n=3), partial recovery in 17% (n=1), and mortality in 33% cases (n=2). Deaths were associated with atypical HUS and ARPKD indicating poor prognosis in this subgroup. Hypertensive emergencies in children have diverse etiologies and high morbidity risk. Rapid blood pressure control combined with management of the underlying cause is essential for improving outcomes. Early diagnosis, individualized therapy, and multidisciplinary care remain crucial in reducing adverse outcomes.