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ACEi – CKD hypertension — RACP Paediatrics MCQ

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HardNephrologyACEi – CKD hypertensionRACP Paediatrics

A 10-year-old with CKD stage 3 has persistent proteinuria and confirmed hypertension despite sodium reduction. Potassium is 4.2 mmol/L and renal function is stable. Which antihypertensive class should be prioritised with paediatric-nephrology supervision?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Start an ACE inhibitor with post-initiation blood pressure, creatinine and potassium monitoring

Explanation lettering: B = shown as A · E = shown as B · D = shown as C · A = shown as D · C = shown as E

B is correct. In a child with CKD, hypertension and proteinuria, renin–angiotensin blockade is selected for both blood-pressure and antiproteinuric effects, with renal-specialist oversight and creatinine and potassium monitoring. C can lower pressure but lacks the same first-line antiproteinuric rationale. D falsely treats CKD as an absolute contraindication. E increases hyperkalaemia and kidney-injury risk without routine benefit and should not be initiated. A uses a short-acting agent unsuitable for chronic control and omits safety monitoring. The blood-pressure target and dose are individualised using correctly measured paediatric centiles and CKD severity.

Reference: Royal Children’s Hospital Melbourne: Hypertension in children and adolescents: https://www.rch.org.au/clinicalguide/guideline_index/Hypertension_in_children_and_adolescents/