Congenital anomalies of kidney (CAKUT): hypertensive encephalopathy as a common presentation among children

Introduction: Hypertension in children is commonly due to renal/renovascular conditions, including congenital anomalies which are not uncommon in children, and often do not present at birth or during infancy.Materials and Methods: A retrospective analysis of cases admitted to the Pediatric Intensive Care Unit of a tertiary care teaching hospital in North India from August 2022 to December 2023. All children beyond neonatal period with encephalopathy were assessed. Cases that could not be investigated were excluded. History and physical findings, including vitals on admission, were tabulated; complete blood picture, biochemical hepatic and renal parameters evaluated, CSF analysis and neuroimaging were done in all cases. Further evaluation was need-based.Cases with hypertension with abnormal contrast enhanced abdominal computerized axial tomography (CECT abdomen) are presented.Results: A total of 2578 cases were admitted, with 438 having encephalopathy. 41 cases were excluded. Of the remaining, five had hypertension, and four were diagnosed as renal hypertension. Their biochemical renal parameters and brain neuroimaging were within normal limits, but had an abnormal CECT abdomen.All were in the 12 to 17 year-old-age-group; females were more common and had renal disorders diagnosed for the first time. Encephalopathy improved after blood pressure was controlled, and all were leading normal/ near normal lifestyle in follow up after 12 months.Conclusions: It is suggested that children with encephalopathy and hypertension should have renal imaging done as biochemical parameters may be normal.