Malignant hypertension in children is usually secondary to chronic renal disease. If uncontrolled, the prognosis is poor. Medical management should, therefore, be aggressive even if azotemia is present. Determination of the plasma renin activity is helpful in selecting the appropriate antihypertensive drugs. On rare occasions, however, malignant hypertension may be refractory to medical management, and if hyperreninemia is demonstrated, bilateral nephrectomy may be necessary, irrespective of remaining kidney function.
Siegler RL. Malignant Hypertension in ChildrenA Patient Treated With Bilateral Nephrectomy. Am J Dis Child. 1974;128(6):853–857. doi:10.1001/archpedi.1974.02110310101021
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