A 12-year-old child with weight in the 75th percentile has a diastolic blood pressure between the 95th and 99th percentile on three separate occasions. Initial tests should include?

A 12-year-old child with weight in the 75th percentile has a diastolic blood pressure between the 95th and 99th percentile on three separate occasions. Initial tests should include?

• A. Complete blood count
• B. Erythrocyte sedimentation rate
• C. Renal function and plasma renin tests
• D. Urinalysis and electrolytes

Answer: (B)

When a child has persistent diastolic hypertension, the priority is to look for a secondary cause, especially kidney-related disease, since renal issues are a common and treatable source in pediatrics. The most useful first step is a urinalysis combined with electrolytes (plus basic renal function). A urinalysis can reveal proteinuria or microscopic hematuria, which point toward glomerular disease or nephropathy, while checking electrolytes and renal function shows how well the kidneys are handling fluid balance and electrolyte management. This direct screen for kidney involvement guides the next steps, such as more detailed renal testing or imaging, if abnormalities are found. Erythrocyte sedimentation rate is a nonspecific inflammation marker and, while it can be informative in systemic inflammatory or vasculitic processes, it does not reliably identify renal causes of hypertension or provide actionable information for initial screening. So it isn’t the best first test in this scenario.

When a child has persistent diastolic hypertension, the priority is to look for a secondary cause, especially kidney-related disease, since renal issues are a common and treatable source in pediatrics. The most useful first step is a urinalysis combined with electrolytes (plus basic renal function). A urinalysis can reveal proteinuria or microscopic hematuria, which point toward glomerular disease or nephropathy, while checking electrolytes and renal function shows how well the kidneys are handling fluid balance and electrolyte management. This direct screen for kidney involvement guides the next steps, such as more detailed renal testing or imaging, if abnormalities are found.

Erythrocyte sedimentation rate is a nonspecific inflammation marker and, while it can be informative in systemic inflammatory or vasculitic processes, it does not reliably identify renal causes of hypertension or provide actionable information for initial screening. So it isn’t the best first test in this scenario.