24-hour blood pressure profile in children with chronic pyelonephritis and chronic kidney disease stages I–III

L.I. Vakulenko


Background. Blood pressure (BP) monitoring is important for the management of patients with chronic kidney disease (CKD), both for the conventional cardiovascular risk reduction and long-term preservation of kidney function. The purpose was to study the features of 24-hour blood pressure profile in children with chronic pyelonephritis (CPN) and CKD stages ІІІІ. Materials and methods. A total of 94 patients aged from 6 to 17 years with chronic pyelonephritis in remission and CKD stages ІІІІ were examined. ­24-hour ambulatory blood pressure monitoring (ABPM) was carried out followed by mathematical processing. Results. Thus, a comparative analysis of the systolic (SBP) and diastolic blood pressure (DBP) indicators obtained within a single BP measurement and during 24-hour ABPM showed their differences in 25.5 % of cases. According to ABPM findings, 22.3 % of CKD children demonstrated elevated BP and 34.0 % — arterial hypertension (АН). It was found that the relative number of patients with sustained and labile AH gradually increased with a decrease in renal functions (mild-to-moderate CKD progression). The analysis of night-time BP dipping degree in patients with CKD revealed a gradual decrease in the relative number of patients with optimal BP dipping for both SBP (from 61.7 % in CKD stage I to 47.1 % in CKD stage III) and DBP (53.2 and 11.8 %, respectively; р = 0.0049). Night-peakers with night-time stable elevation of SBP (11.8 %) and DBP (29.4 %) were the patients with CKD stage III. Conclusions. The number of hypertensive patients increases among CPN children during CKD progression. AH in children with progressive nephropathy is characterized by a greater contribution from DBP and stable elevation of night-time BP.


blood pressure; 24-hour blood pressure profile; children; chronic pyelonephritis; chronic kidney disease

Full Text:



Di Lullo L, Bellasi A, De Pascalis A. Hypertension, type IV cardiorenal syndrome and chronic kidney disease: Pathophysiological and therapeutical approach. World J Hypertens 2017;7(1):10-18. doi: 10.5494/wjh.v7.i1.10.

Edmonston D, Morris JD, Middleton JP. Working Toward an Improved Understanding of Chronic Cardiorenal Syndrome Type 4. Adv Chronic Kidney Dis. 2018 Sep;25(5):454-467. doi: 10.1053/j.ackd.2018.08.010.

Rangaswami J, Bhalla V, Blair JEA, et al. Cardiorenal Syndrome: Classification, Pathophysiology, Diagnosis, and Treatment Strategies: A Scientific Statement From the American Heart Association. Circulation. 2019 Apr 16;139(16):e840-e878. doi: 10.1161/CIR.0000000000000664.

Kaddourah A, Goldstein SL. Childhood Cardiorenal Syndrome. In: Jefferies JL, Chang AC, Rossano JW, Shaddy RE, Towbin JA, editors. Heart Failure in the Child and Young Adult, Chapter 31. Academic Press; 2018. 824 p. doi: 10.1016/C2014-0-01738-8.

Pinheiro da Silva AL, Vaz da Silva MJ. Type 4 cardiorenal syndrome. Rev Port Cardiol. 2016 Nov;35(11):601-616. doi: 10.1016/j.repc.2016.06.007.

Vidi SR. Role of hypertension in progression of chronic kidney disease in children. Curr Opin Pediatr. 2018 Apr;30(2):247-251. doi: 10.1097/MOP.0000000000000595.

Bilo G, Grillo A, Guida V, Parati G. Morning blood pressure surge: pathophysiology, clinical relevance and therapeutic aspects. Integr Blood Press Control. 2018 May 24;11:47-56. doi: 10.2147/IBPC.S130277.

Gabriele MM, Koch Nogueira PC. Management of Hypertension in CAKUT: Protective Factor for CKD. Front Pediatr. 2019 Jun 4;7:222. doi: 10.3389/fped.2019.00222.

Waraby BA, Abraham AG, Schwartz GJ, et al. Predictors of rapid progression of glomerular and nonglomerular kidney disease in children and adolescents: the chronic kidney disease in children (CKiD) cohort. Am J Kidney Dis. 2015 Jun;65(6):878-88. doi: 10.1053/j.ajkd.2015.01.008. 

Aksenova ME, Konkova NE, Lepaeva TV, Kyrganova TA, Dlin VV. Diagnostic value of a single blood pressure reading for the detection of latent hypertension in children with chronic kidney diseases. Rossiyskiy vestnik perinatologii i pediatrii. 2018;62(2):54-59. doi: 10.21508/1027-4065-2017-62-2-54-59. (in Russian).

Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics. 2017 Sep;140(3). pii: e20171904. doi: 10.1542/peds.2017-1904.

Hamrahian SM, Falkner B. Hypertension in Chronic Kidney Disease. Adv Exp Med Biol. 2017;956:307-325. doi: 10.1007/5584_2016_84.

Lande MB, Mendley SR, Matheson MB, et al. Association of blood pressure variability and neurocognition in children with chronic kidney disease. Pediatr Nephrol. 2016 Nov;31(11):2137-44. doi: 10.1007/s00467-016-3425-2.  

Barletta GM, Flynn J, Mitsnefes M, et al. Heart rate and blood pressure variability in children with chronic kidney disease: a report from the CKiD study. Pediatr Nephrol. 2014 Jun;29(6):1059-65. doi: 10.1007/s00467-013-2737-8.

Cilsal E, Koc AS. Renal resistive index significantly increased in hypertensive children and it is independently related to the pulse pressure and left ventricular mass index. Clin Exp Hypertens. 2018 Oct 4:1-8. doi: 10.1080/10641963.2018.1523920.

Mitsnefes MM, Pierce C, Flynn J, et al. Can office blood pressure readings predict masked hypertension? Pediatr Nephrol. 2016 Jan;31(1):163-6. doi: 10.1007/s00467-015-3212-5.

Andrade H, Pires A, Noronha N, et al. Importance of ambulatory blood pressure monitoring in the diagnosis and prognosis of pediatric hypertension. Rev Port Cardiol. 2018 Sep;37(9):783-789. doi: 10.1016/j.repc.2017.09.026.

Gupta D, Chaturvedi S, Chandy S, Agarwal I. Role of 24-h ambulatory blood pressure monitoring in children with chronic kidney disease. Indian J Nephrol. 2015 Nov-Dec;25(6):355-61. doi: 10.4103/0971-4065.148305.

Peterson CG, Miyashita Y. The Use of Ambulatory Blood Pressure Monitoring As Standard of Care in Pediatrics. Front Pediatr. 2017 Jun 30;5:153. doi: 10.3389/fped.2017.00153.

Fedecostante M, Spannella F, Cola G, Espinosa E, Dessì-Fulgheri P, Sarzani R. Chronic kidney disease is characterized by "double trouble" higher pulse pressure plus night-time systolic blood pressure and more severe cardiac damage. PLoS One. 2014 Jan 23;9(1):e86155. doi: 10.1371/journal.pone.0086155.

Che X, Mou S, Zhang W, et al. The impact of non-dipper circadian rhythm of blood pressure on left ventricular hypertrophy in patients with non-dialysis chronic kidney disease. Acta Cardiol. 2017 Apr;72(2):149-155. doi: 10.1080/00015385.2017.1291133.

Johnson AW, Hissen AL, Macefield VG, Brown R, Taylor CE. Magnitude of Morning Surge in Blood Pressure Is Associated with Sympathetic but Not Cardiac Baroreflex Sensitivity. Front Neurosci. 2016 Sep 8;10:412. doi: 10.3389/fnins.2016.00412.

Kıvrak A, Özbiçer S, Kalkan GY, Gür M. Morning blood pressure surge and arterial stiffness in newly diagnosed hypertensive patients. Blood Press. 2017 Jun;26(3):181-190. doi: 10.1080/08037051.2017.1278678.

Mahfouz RA, Goda M, Galal I, Ghareb MS. Association of morning blood pressure surge with carotid intima-media thickness and cardiac dysfunction in patients with cardiac syndrome-X. Blood Press. 2018 Oct;27(5):297-303. doi: 10.1080/08037051.2018.1476056.

Sheppard JP, Hodgkinson J, Riley R, Martin U, Bayliss S, McManus RJ. Prognostic significance of the morning blood pressure surge in clinical practice: a systematic review. Am J Hypertens. 2015 Jan;28(1):30-41. doi: 10.1093/ajh/hpu104.

Copyright (c) 2019 KIDNEYS

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.


© "Publishing House "Zaslavsky", 1997-2019


   Seo анализ сайта