A 12-year-old has repeated stage-2 hypertension, an abdominal bruit, potassium 3.0 mmol/L and raised renin. Four-limb pressures show no gradient and

Question

A 12-year-old has repeated stage-2 hypertension, an abdominal bruit, potassium 3.0 mmol/L and raised renin. Four-limb pressures show no gradient and urinalysis is bland. What is the most appropriate investigation pathway?

Accepted Answer

Arrange renal vascular imaging and paediatric nephrology assessment

Answer

Use echocardiography as the sole test because normal urine excludes renal causes

Answer

Diagnose primary hypertension and defer secondary investigation until lifestyle therapy fails

Answer

Order plasma metanephrines alone because hypokalaemia excludes renovascular disease

Answer

Start spironolactone and infer primary aldosteronism without vascular imaging

Hypertension due to renal artery stenosis — RACP Paediatrics MCQ

A 12-year-old has repeated stage-2 hypertension, an abdominal bruit, potassium 3.0 mmol/L and raised renin. Four-limb pressures show no gradient and urinalysis is bland. What is the most appropriate investigation pathway?