Hypertensive crisis in children with chronic kidney disease after instituting antitubercular therapy: A case series

Abstract

Tuberculosis is common in chronic kidney disease (CKD). There are reports of adults with CKD experiencing hypertensive crises and an increase in dosages and number of antihypertensive drugs after starting antitubercular therapy (ATT). Studies have demonstrated that rifampicin could increase the metabolism of beta-blockers, calcium channel blockers, and prazosin. There are no studies or reports of worsening blood pressure (BP) control in children with CKD after starting ATT. Here, we report three cases of children who developed hypertensive crises after starting ATT. All patients presented in emergency with the acute severe rise of BP with breathlessness and or visual blurring. All of them showed retinal changes suggestive of malignant hypertension. They needed parenteral therapy to control BP. They also needed the escalation of antihypertensives and the addition of other drugs. One patient needed a withdrawal of rifampicin. It is suggested that children with CKD should be monitored for BP control after instituting ATT.

Keywords

• blood pressure
• dialysis
• malignant hypertension
• rifampicin