Abstract
Background
The aim of this study was to investigate renal function and injury in infants and young children with congenital heart disease (CHD).
Methods
We prospectively enrolled 58 CHD children aged ≤3 years and 20 age-matched controls and divided these into four groups: Group I, acyanotic CHD (n = 24); Group II, cyanotic CHD with arterial oxygen saturation of >75 % (n = 20); Group III, cyanotic CHD with arterial oxygen saturation of ≤75 % (n = 14); Group IV, normal controls (n = 20). Urinary levels of microalbumin (MA), N-acetyl-ß-D-glucosaminidase (NAG), and α1-microglobulin (α1-MG) corrected by creatinine (UCr) were compared.
Results
Children with CHD had elevated urinary α1-MG/UCr levels, with Group III children having the highest level. Groups I and III children had higher urinary NAG/UCr levels than those of Groups II and IV. Urinary MA/UCr levels in the three patient groups were comparable and significantly higher than that in the control group. A α1-MG × 100/ (α1-MG + MA) of <15 %, indicative of glomerular damage, was present in two patients in Group I and one in Group III, but none in Group II.
Conclusions
Tubular injury can occur in CHD patients during infancy and early childhood. Among our patient cohort, it was most prominent in children with severe cyanosis. Glomerular injury was detected in some individuals with advanced heart failure or severe cyanosis.
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References
Dittrich S, Haas NA, Buhrer C, Muller C, Dahnert I, Lange PE (1998) Renal impairment in patients with long-standing cyanotic congenital heart disease. Acta Paediatr 87:949–954
Krull F, Ehrich JH, Wurster U, Toel U, Rothganger S, Luhmer I (1991) Renal involvement in patients with congenital cyanotic heart disease. Acta Paediatr Scand 80:1214–1219
Dimopoulos K, Diller GP, Koltsida E, Pijuan-Domenech A, Papadopoulou SA, Babu-Narayan SV, Salukhe TV, Piepoli MF, Poole-Wilson PA, Best N, Francis DP, Gatzoulis MA (2008) Prevalence, predictors, and prognostic value of renal dysfunction in adults with congenital heart disease. Circulation 117:2320–2328
Flanagan MF, Hourihan M, Keane JF (1991) Incidence of renal dysfunction in adults with cyanotic congenital heart disease. Am J Cardiol 68:403–406
Birn H, Christensen EI (2006) Renal albumin absorption in physiology and pathology. Kidney Int 69:440–449
Lun A, Suslovych M, Drube J, Ziebig R, Pavicic L, Ehrich JH (2008) Reliability of different expert systems for profiling proteinuria in children with kidney diseases. Pediatr Nephrol 23:285–290
Seeman T, Dusek J, Vondrak K, Spatenka J, Feber J (2009) Profiling proteinuria in children after renal transplantation. Pediatr Nephrol 24:2439–2444
Kemper MJ, Muller-Wiefel DE (2001) Renal function in congenital anomalies of the kidney and urinary tract. Curr Opin Urol 11:571–575
Eckardt KU, Bernhardt WM, Weidemann A, Warnecke C, Rosenberger C, Wiesener MS, Willam C (2005) Role of hypoxia in the pathogenesis of renal disease. Kidney Int Suppl:S46-51
Sahai A, Mei C, Schrier RW, Tannen RL (1999) Mechanisms of chronic hypoxia-induced renal cell growth. Kidney Int 56:1277–1281
Akita H, Matsuoka S, Kuroda Y (1993) Nephropathy in patients with cyanotic congenital heart disease. Tokushima J Exp Med 40:47–53
Agras PI, Derbent M, Ozcay F, Baskin E, Turkoglu S, Aldemir D, Tokel K, Saatci U (2005) Effect of congenital heart disease on renal function in childhood. Nephron Physiol 99:10–15
Burlet A, Drukker A, Guignard JP (1999) Renal function in cyanotic congenital heart disease. Nephron 81:296–300
Inatomi J, Matsuoka K, Fujimaru R, Nakagawa A, Iijima K (2006) Mechanisms of development and progression of cyanotic nephropathy. Pediatr Nephrol 21:1440–1445
Jungbauer CG, Birner C, Jung B, Buchner S, Lubnow M, von Bary C, Endemann D, Banas B, Mack M, Boger CA, Riegger G, Luchner A (2011) Kidney injury molecule-1 and N-acetyl-beta-D-glucosaminidase in chronic heart failure: possible biomarkers of cardiorenal syndrome. Eur J Heart Fail 13:1104–1110
D’Amico G, Bazzi C (2003) Urinary protein and enzyme excretion as markers of tubular damage. Curr Opin Nephrol Hypertens 12:639–643
Awad H, El-Safty I, Abdel-Gawad M, El-Said S (2003) Glomerular and tubular dysfunction in children with congenital cyanotic heart disease: effect of palliative surgery. Am J Med Sci 325:110–114
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We sincerely thank all of the children who participated in this study and their legal guardians for supporting our work.
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Zheng, J., Yao, Y., Han, L. et al. Renal function and injury in infants and young children with congenital heart disease. Pediatr Nephrol 28, 99–104 (2013). https://doi.org/10.1007/s00467-012-2292-8
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DOI: https://doi.org/10.1007/s00467-012-2292-8