Early kidney damage in children and adolescents with primary arterial hypertension: a systematic review.

Primary arterial hypertension (PAH) in children and adolescents is increasingly recognized as a significant health issue that may lead to early kidney damage. This systematic review aims to summarize current evidence on renal impairment in pediatric PAH. A systematic literature search was conducted in the PubMed, CINAHL, and Web of Science databases for studies published in English between 2013 and August 2025, with the final search performed on 28 October 2025. Eligible studies included participants aged 1 month to 17 years with PAH who reported at least one renal outcome, such as glomerular filtration rate (GFR), proteinuria/albuminuria, or other renal biomarkers. Studies including infants (< 1 month), adults (> 17 years), or children with chronic kidney disease or other comorbidities were excluded. Two reviewers independently screened and selected studies based on predefined inclusion and exclusion criteria. Study quality was assessed using the Newcastle-Ottawa Scale. Study characteristics and outcomes were summarized in tables, and key findings were described narratively. A total of 20 studies involving more than 2000 children with PAH were included. Proteinuria and microalbuminuria were the most commonly reported indicators of renal involvement, though evidence of statistical significance varied across studies. Twelve studies reported proteinuria or albuminuria above threshold values in 0.8-36% of participants. For example, Yang et al. reported a statistically significant 25.9% prevalence of albuminuria (p = 0.003). Several studies noted glomerular hyperfiltration, while others reported normal GFR values. Data on renal biomarkers such as cystatin C, β₂-microglobulin, and N-acetyl-β-D-glucosaminidase were limited and showed inconsistent associations with hypertension. Additionally, variations in blood pressure measurement techniques, diagnostic criteria, and population characteristics, including obesity prevalence, contributed to differences across studies.

conclusionEvidence suggests that early kidney damage, particularly albuminuria and changes in GFR, may be present in children with PAH. However, significant variability among studies underscores the need for standardized methodologies and long-term research to clarify the impact of PAH on renal injury in the pediatric population. WHAT IS KNOWN: • PAH in children is increasingly prevalent, closely linked to obesity and lifestyle factors. • Hypertension-related kidney damage is well established in adults, but pediatric data remain limited. WHAT IS NEW: • This review highlights possible early signs of renal involvement in pediatric PAH, including microalbuminuria and glomerular hyperfiltration. • Variability in diagnostic criteria and study designs limits comparability; this review emphasizes the need for standardized, long-term pediatric studies.