Pediatric hypertension is increasingly recognized as a complex condition shaped by both systemic and cellular factors, with oxidative stress emerging as a key driver of vascular dysfunction. In both their primary and secondary forms, reactive oxygen species (ROS) disrupt redox homeostasis, impair endothelial signaling, and promote inflammation and tissue remodeling. Metabolic dysregulation, renal pathology, and early-life stressors contribute to the accumulation of ROS through pathways involving NADPH oxidases, mitochondrial dysfunction, xanthine oxidase activity, and altered arginine metabolism. These mechanisms converge on the vasculature, diminishing nitric oxide bioavailability and promoting hypertensive phenotypes. Beyond disease initiation, redox imbalance influences the response to treatment, surgical outcomes, and long-term cardiovascular risk. By further elucidating these mechanisms, the complex relationship between oxidative stress, vascular biology, and blood pressure regulation in children may be more clearly defined and more effectively targeted in clinical management.

BACKGROUND: Hypertension is a growing concern worldwide, with increasing prevalence rates in both children and adults. Most cases of hypertension are multifactorial, with various genetic, environmental, socioeconomic, and lifestyle influences. However, monogenic hypertension, a blanket term for a group of rare hypertensive disorders, is caused by single-gene mutations that are typically inherited in an autosomal dominant fashion, and ultimately disrupt normal blood pressure regulation in the kidney or adrenal gland. Being able to recognize and understand the pathophysiology of these rare disorders is critical for properly diagnosing hypertension, particularly in children and young adults, as treating each form of monogenic hypertension requires specific and targeted treatment approaches. METHODS: A scoping literature review was conducted on the available knowledge regarding each of the disorders currently categorized as forms of monogenic hypertension. RESULTS: This narrative review serves to highlight the epidemiology, pathophysiology, clinical presentation, recent case reports, and most current methods of evaluation and treatment for familial hyperaldosteronism types 1–4, Gordon syndrome. Liddle syndrome, syndrome of apparent mineralocorticoid excess, congenital adrenal hyperplasia, Geller syndrome, hereditary syndromes related to pheochromocytomas and paragangliomas, and brachydactyly type E. CONCLUSIONS: Recent and future advances in genetic analysis techniques will further enhance the diagnosis and early management of these disorders, preventing the consequences of uncontrolled hypertension.

Key Points: Despite a high need and interest in point-of-care ultrasound (POCUS) in trainees and faculty of Pediatric Nephrology, the majority are not receiving POCUS training. There is a need to establish a structured pediatric nephrology POCUS program for clinicians and fellows. This study suggests a blueprint of POCUS curriculum which can serve as a foundation for POCUS education in pediatric nephrology centers worldwide. Background: Point-of-care ultrasound (POCUS) is commonly used in adult specialties, pediatric emergency medicine, and neonatal and pediatric critical care. Specifically, in the field of pediatric nephrology, POCUS plays a valuable role in the critical inpatient and outpatient settings. However, the lack of guidelines and a standardized curriculum for POCUS in pediatric nephrology has led to substantial discrepancies in both clinical practice and training. Methods: A multinational, multicenter survey regarding POCUS usefulness and training was sent to 225 pediatric nephrology residents, fellows, and physicians with expertise in pediatric nephrology. On the basis of the results, an ideal pediatric nephrology POCUS curriculum was formulated with a panel of experts from across the world. Eighteen experts were included, with each expert having >10 years of experience in using POCUS in adult and pediatric nephrology. A Delphi method was used to further solidify guidelines regarding the content, curriculum, and vital skills of using POCUS in pediatric nephrology. Results: A total of 134 pediatric nephrology trainees, specialists, and faculty responded to the survey (59.6% completion rate). A total of 87.4% of respondents believe that formal POCUS training is either highly desirable or should be mandatory in pediatric nephrology fellowship programs. Identified barriers to receiving training included lack of an organized curriculum, lack of POCUS experts and pediatric intensivists, lack of ultrasound equipment, lack of financial support, and lack of dedicated time during training. An expert panel was convened, and a Delphi survey was conducted to formulate guidelines to overcome the barriers to pediatric nephrology POCUS and standardize the training process. Conclusions: After collaborating with prominent pediatric nephrologists, global POCUS experts proposed a comprehensive POCUS training curriculum tailored specifically for pediatric nephrology trainees, with an appeal for all pediatric nephrology education programs to integrate POCUS instruction into their curricula.

Background: Chronic kidney disease (CKD) poses a significant global health challenge; however, its burden on pediatric populations remains underexplored. This study assesses the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of pediatric CKD attributable to type 1 diabetes mellitus, type 2 diabetes mellitus, hypertension, glomerulonephritis, and congenital anomalies of the kidney and urinary tract from 1990 to 2021. Methods: Data were extracted from the Global Burden of Disease (GBD) 2021 database. CKD burden was stratified by etiology, age, sex, sociodemographic index (SDI), and geography. Average annual percentage changes (AAPCs) in incidence, prevalence, mortality, and DALYs were calculated. Results: Globally, CKD-related mortality and DALYs decreased for type 1 diabetes mellitus (-2.176% AAPC), type 2 diabetes mellitus (-1.556%), glomerulonephritis (-0.854%), hypertension (-0.800%), and congenital anomalies of the kidney and urinary tract (-2.143%). The incidence of hypertension incidence increased (+1.299%). Boys experienced higher incidence and prevalence rates for all etiologies, while girls had more significant reductions in mortality and DALYs. High-SDI regions showed the steepest declines in CKD burden, while low-SDI regions experienced limited reductions and increasing hypertension prevalence. Conclusions: Pediatric CKD burden reflects disparities by etiology, geography, and SDI. Interventions to improve early diagnosis, healthcare access, and targeted management strategies, particularly in low-SDI regions, are essential. Addressing obesity and improving treatment for glomerulonephritis are priorities. Standardized diagnostic criteria and broader global efforts are needed to mitigate the burden of pediatric CKD.

There is an established link between air pollution and chronic disease. In this study, we measure the impact and health burden of fine particulate matter (PM_2.5) in chronic disease in the United States (USA), specifically type 2 diabetes mellitus (T2DM), chronic obstructive pulmonary disease (COPD), ischaemic heart disease (IHD) and stroke. Data on the global burden of chronic disease attributable to air pollution were obtained from Global Burden of Diseases (GBD) 2021 study. The number of deaths and disability-adjusted life years (DALYs) attributable to air pollution from 1990 to 2021 were extracted and analysed by different US locations and years. The death rates due to chronic diseases attributable to PM_2.5 in the USA have decreased significantly. In 2021, death rates were lowest for T2DM (1.307), followed by stroke (2.004), COPD (2.119) and IHD (5.865). Between 1990 and 2021, death rates declined by 36% for T2DM, 30% for COPD, 70% for IHD and 61% for stroke. DALY rates in 2021 were lowest for stroke (52.389), followed by COPD (54.147), T2DM (73.32) and IHD (119.471), with reductions of 16.4%, 39.6%, 70.3% and 58.9%, respectively, since 1990. High-sociodemographic index (SDI; a measure of social and economic development) states saw greater improvements, with average annual percentage change (AAPCs) of -5.2% for IHD and -2.68% for COPD, compared to -4.4% and -1.35% in low-SDI states. Higher-income states also showed faster declines, such as an AAPC of COPD death rates of -2.51% versus -1.21% in low-income states. The results highlight a decreasing trend in death rates and DALYs and identify varying locations that remain at high risk of health burden from PM_2.5-associated chronic disease. There is a continued need for addressing air pollution control and policy revisions targeted to patient subpopulations in the USA where the burden of PM_2.5 can still be detrimental.