Introduction
This guideline relates to hypertension in paediatric patients and should be implemented in consultation with The Royal Children's Hospital Clinical
Practice Guidelines: Hypertension in children and adolescents.
When to refer
- Patients <18 years
- BP>99th percentile and symptomatic (Urgent <30 days). Symptoms include:
- Headache
- Nausea
- Vomiting
- Abdominal pain
- Neurological changes (Seizures, CCF, blurred vision)
- Hypertension with extra renal manifestations (joint pain, rash, joint swelling, hemoptysis, dyspnoea, cough or oedema)
- BP>95th percentile and asymptomatic (non-urgent >90 days)
If any of the following are present or suspected, please direct the patient to the Emergency Department ( no referral required):
- Symptomatic hypertension
- BP> 180/110 in adolescents
- BP >30mmHg above the 95th percentile for age
Wait times for appointment
Specialist Clinics wait times
(Please note, non-urgent referrals for patients over the age of 16 may be declined if it is likely they will not be seen before their 18th birthday).
Services closer to home
- Monash Children's Hospital
Referral criteria
Starred items (*) are
mandatory.
- *Details of
clinical concern requiring nephrologist input, including duration of symptoms
and details of all treatments offered to date
- *Growth charts,
including current height and weight
- *Observations
including BP
- *Blood tests
- *Electrolytes,
urea, creatinine (EUC)
- *Full blood count
(FBC)
- Consider renin and aldosterone
- *Urine tests:
- *Urine microscopy
and culture (MCS)
- *Early morning
urine total protein: creatinine ratio (NOT albumin:creatinine ratio)
- *Renal ultrasound
report
Failure to include reports of pathology and
radiology investigations will result in the referral being returned to the
referring doctor for resubmission. A written summary of the renal ultrasound
report will not be accepted.
Referrals from public hospitals MUST INCLUDE the name and
contact details of a consultant supervising paediatrician/neonatologist and GP.
The patient remains in the care of the referrer until such time that they
are seen in the Kidney Clinic.
How to refer
Specialist Clinics referral
Please complete the above and submit via:
- Facsimile (03) 9345 5034 or
- Email screferrals@rch.org.au
- Urgent referral or clinical query call
ED admitting officer or Nephrologist on-call (03) 9345 5522
Suggested pre-referral management
- If BP on 90th-95th percentile for age but patient is asymptomatic, review lifestyle measures and monitor
- Medical management may be initiated in young adults with stage 1 hypertension in line with the RCH Hypertension CPG.
Information for families
Your child’s referral will be triaged based on the information received
in the referral. Your referrer will continue to monitor and manage your child’s
care prior to and after your consultation. If there is a change in the
clinical situation, a new referral explaining the need for re-triage of the referral
is required. If you are seen elsewhere, please cancel your appointment with our service so that we can provide service to another child on our wait list.
Resources and links
Acknowledgements
The development of this guideline was coordinated by the Department of Nephrology. Guideline reviewed in June 2026