Limits...
Renal function in children with cyanotic congenital heart disease: pre- and post-cardiac surgery evaluation.

Amoozgar H, Basiratnia M, Ghasemi F - Iran J Pediatr (2014)

Bottom Line: Final GFR was significantly and inversely associated with pre- and post-operation age (P=0.008 r=-0.48, P=0.03 r=-0.38).Patients with preoperation hematocrit >45 had a significantly lower final GFR compared to children with HCT <45 (83.7±6.5 vs 111.10.2, P=0.001).Pre-operative HCT was inversely associated to FEua (P=0.01, r=-0.44).

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Cardiology, Nemazee Hospital.

ABSTRACT

Objective: Cyanotic congenital heart diseases (CCHDs) are a series of cardiac anomalies that have long been recognized as a potential cause of nephropathy. There have been few reports on renal impairment in patients with CCHD before and after corrective cardiac surgery. The aim of this study was to evaluate the prevalence of renal dysfunction before and after cardiac surgery and the impact of some risk factors on final renal outcome.

Methods: Thirty children with CCHD who had done corrective cardiac surgery in the previous 6 months were enrolled in this study. All data prior to surgery were collected from the charts. Post-operation data including blood and spot urine samples were taken simultaneously for CBC, Cr, and uric acid and 24 hour urine was collected for microalbumin and Cr during the follow up visits. Pre- and post-operation parameters were compared to study the impact of cardiac surgery on renal function. Findings : Pre- and post-operative GFRs were not significantly different. Final GFR was significantly and inversely associated with pre- and post-operation age (P=0.008 r=-0.48, P=0.03 r=-0.38). Three (10%) patients had microalbuminuria. The prevalence of microalbuminuria in children older than 10 years was 30%. There was no link between microalbuminuria and age, GFR, and hematocrit (P=0.1, P=0.3, P=0.3, respectively). Patients with preoperation hematocrit >45 had a significantly lower final GFR compared to children with HCT <45 (83.7±6.5 vs 111.10.2, P=0.001). The mean uric acid fraction (FEua) excretion was 8.21±4.75. Pre-operative HCT was inversely associated to FEua (P=0.01, r=-0.44). There was no relationship between FEua and age, serum uric acid, and GFR (P=0.7, P=0.4, P=0.2).

Conclusion: Children with CCHD are at increased risk of renal injury which is related more to the duration of cyanosis and higher degree of hematocrit level. To lower the risk, corrective cardiac surgery is recommended to be done as soon as possible to improve renal function and stop more renal impairment.

No MeSH data available.


Related in: MedlinePlus

Flow chart of participants in the study
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4359609&req=5

Figure 1: Flow chart of participants in the study

Mentions: In a cross-sectional study over a period of 8 months (September 2011- April 2012), 30 patients with CCHD who referred to the Pediatric Cardiology Clinic affiliated with Shiraz University of Medical Sciences, and at least 6 months had passed from their corrective cardiac surgery were selected (Fig 1). The study was reviewed and approved by the university review board and ethics committee. All parents have given informed consent prior to the study. Exclusion criteria were renal anomalies, endocarditis, diabetes mellitus, acute infection, and recently used nephrotoxic drugs. Pre-operation clinical and laboratory data including age, height, CBC, and serum Cr were recruited from admission chart at the time of surgery. Post-operation data including blood and spot urine samples were taken simultaneously for CBC, Cr, and uric acid during the last follow up visit (at least 6 months after cardiac surgery). Uric acid was measured in plasma by spectrophotometry method and plasma and urine cretinine by Jaffe kinetic method. FEUA as a tubular marker was calculated by formula: (urine UA×plasma Cr)/(plasma UA×urine Cr). 24 hour urine was collected for micro-albumin and Cr. Microalbumin assay was done by enzyme linked immunosorbent. Estimated GFR was calculated by Schwartz formula [GFR (ml/min/1.73m2)= κ×height (cm)/serum Cr (mg/dl)].


Renal function in children with cyanotic congenital heart disease: pre- and post-cardiac surgery evaluation.

Amoozgar H, Basiratnia M, Ghasemi F - Iran J Pediatr (2014)

Flow chart of participants in the study
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4359609&req=5

Figure 1: Flow chart of participants in the study
Mentions: In a cross-sectional study over a period of 8 months (September 2011- April 2012), 30 patients with CCHD who referred to the Pediatric Cardiology Clinic affiliated with Shiraz University of Medical Sciences, and at least 6 months had passed from their corrective cardiac surgery were selected (Fig 1). The study was reviewed and approved by the university review board and ethics committee. All parents have given informed consent prior to the study. Exclusion criteria were renal anomalies, endocarditis, diabetes mellitus, acute infection, and recently used nephrotoxic drugs. Pre-operation clinical and laboratory data including age, height, CBC, and serum Cr were recruited from admission chart at the time of surgery. Post-operation data including blood and spot urine samples were taken simultaneously for CBC, Cr, and uric acid during the last follow up visit (at least 6 months after cardiac surgery). Uric acid was measured in plasma by spectrophotometry method and plasma and urine cretinine by Jaffe kinetic method. FEUA as a tubular marker was calculated by formula: (urine UA×plasma Cr)/(plasma UA×urine Cr). 24 hour urine was collected for micro-albumin and Cr. Microalbumin assay was done by enzyme linked immunosorbent. Estimated GFR was calculated by Schwartz formula [GFR (ml/min/1.73m2)= κ×height (cm)/serum Cr (mg/dl)].

Bottom Line: Final GFR was significantly and inversely associated with pre- and post-operation age (P=0.008 r=-0.48, P=0.03 r=-0.38).Patients with preoperation hematocrit >45 had a significantly lower final GFR compared to children with HCT <45 (83.7±6.5 vs 111.10.2, P=0.001).Pre-operative HCT was inversely associated to FEua (P=0.01, r=-0.44).

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Cardiology, Nemazee Hospital.

ABSTRACT

Objective: Cyanotic congenital heart diseases (CCHDs) are a series of cardiac anomalies that have long been recognized as a potential cause of nephropathy. There have been few reports on renal impairment in patients with CCHD before and after corrective cardiac surgery. The aim of this study was to evaluate the prevalence of renal dysfunction before and after cardiac surgery and the impact of some risk factors on final renal outcome.

Methods: Thirty children with CCHD who had done corrective cardiac surgery in the previous 6 months were enrolled in this study. All data prior to surgery were collected from the charts. Post-operation data including blood and spot urine samples were taken simultaneously for CBC, Cr, and uric acid and 24 hour urine was collected for microalbumin and Cr during the follow up visits. Pre- and post-operation parameters were compared to study the impact of cardiac surgery on renal function. Findings : Pre- and post-operative GFRs were not significantly different. Final GFR was significantly and inversely associated with pre- and post-operation age (P=0.008 r=-0.48, P=0.03 r=-0.38). Three (10%) patients had microalbuminuria. The prevalence of microalbuminuria in children older than 10 years was 30%. There was no link between microalbuminuria and age, GFR, and hematocrit (P=0.1, P=0.3, P=0.3, respectively). Patients with preoperation hematocrit >45 had a significantly lower final GFR compared to children with HCT <45 (83.7±6.5 vs 111.10.2, P=0.001). The mean uric acid fraction (FEua) excretion was 8.21±4.75. Pre-operative HCT was inversely associated to FEua (P=0.01, r=-0.44). There was no relationship between FEua and age, serum uric acid, and GFR (P=0.7, P=0.4, P=0.2).

Conclusion: Children with CCHD are at increased risk of renal injury which is related more to the duration of cyanosis and higher degree of hematocrit level. To lower the risk, corrective cardiac surgery is recommended to be done as soon as possible to improve renal function and stop more renal impairment.

No MeSH data available.


Related in: MedlinePlus