Question:medium
A seven year old asymptomatic girl is found to have persistent hypertension. There is no significant history and urine examination is normal. Which of the following is the most likely cause?
A seven year old asymptomatic girl is found to have persistent hypertension. There is no significant history and urine examination is normal. Which of the following is the most likely cause?
Show Hint
In young children most hypertension is secondary, and the commonest group is renal.
Updated On: Jun 24, 2026
- Essential hypertension
- Renal parenchymal disease
- Polycystic kidney disease
- Coarctation of aorta
Show Solution
The Correct Option is B
Solution and Explanation
Anchor on one rule of pediatrics: a hypertensive child almost always has a secondary cause, and at seven years a primary cause is unlikely. So the task is to pick the commonest secondary cause.
Among the kidney, vessel and endocrine causes of childhood hypertension, renal causes dominate, and within those the parenchymal disorders (chronic glomerulonephritis, reflux nephropathy, post-infectious scarring) form the largest single group. A normal urinalysis is reassuring but does not exclude them, because long-standing scarred kidneys often produce clear urine while still driving the pressure up.
Run through the distractors. True essential hypertension would be expected later, in teenagers, not at age seven. Polycystic kidney disease is only one entity and usually announces itself with flank masses or a family history. Coarctation of the aorta would give upper-limb hypertension with diminished or delayed femoral pulses, a picture the question does not mention.
That leaves renal parenchymal disease as the best fit.
\[\boxed{\text{Renal parenchymal disease}}\]
Among the kidney, vessel and endocrine causes of childhood hypertension, renal causes dominate, and within those the parenchymal disorders (chronic glomerulonephritis, reflux nephropathy, post-infectious scarring) form the largest single group. A normal urinalysis is reassuring but does not exclude them, because long-standing scarred kidneys often produce clear urine while still driving the pressure up.
Run through the distractors. True essential hypertension would be expected later, in teenagers, not at age seven. Polycystic kidney disease is only one entity and usually announces itself with flank masses or a family history. Coarctation of the aorta would give upper-limb hypertension with diminished or delayed femoral pulses, a picture the question does not mention.
That leaves renal parenchymal disease as the best fit.
\[\boxed{\text{Renal parenchymal disease}}\]
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