In pediatric hypertension, which tests are used to assess secondary causes?

• A. Lipid panel, liver enzymes, and glucose tolerance
• B. Measurement of serum renin and aldosterone, metanephrines, and renal ultrasound with Doppler
• C. Complete blood count only
• D. Echocardiography alone

Answer: (B)

In pediatric hypertension, the evaluation for secondary causes centers on the systems most often driving high pressure in kids: the renin–angiotensin–aldosterone axis, catecholamine-producing tumors, and renal structure/blood flow. Measuring serum renin and aldosterone helps detect mineralocorticoid-driven or renovascular hypertension. Screening for metanephrines (plasma or urine) looks for pheochromocytoma or related catecholamine-secreting tumors. A renal ultrasound with Doppler assesses kidney anatomy and blood flow to identify stenosis or parenchymal disease. Together, these tests target the common, treatable secondary etiologies in children. A lipid panel, liver enzymes, and glucose tolerance test don’t specifically uncover secondary hypertension causes. CBC or echocardiography alone wouldn’t identify the underlying secondary etiologies either.