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Prevalence and associated factors of renal dysfunction and proteinuria in cyanotic congenital heart disease

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Abstract

Background

Cyanotic nephropathy (CN), seen in 30–50% of patients with congenital cyanotic heart disease (CCHD), affects both tubular and glomerular function, resulting in proteinuria and azotemia. Microalbuminuria is an early marker for glomerular damage and an independent predictor of progressive renal disease.

Methods

A cross-sectional study was conducted. A total of 116 patients aged 1 month to 15 years with CCHD at Chiang Mai University Hospital between 2015 and 2016 were assessed and 94 patients were enrolled. To determine the prevalence and associated factors of significant albuminuria in CCHD patients, baseline characteristics, oxygen saturation, surgery, hemoglobin (Hb), hematocrit (Hct), spot urine albumin, urine protein, and creatinine were obtained. Binary logistic-regression modeling was used to identify associated factors.

Results

Prevalence of CN in children with CCHD was 58.51% and 92.55% according to albuminuria and proteinuria staging respectively. Prevalence of significant proteinuria, significant albuminuria, and decreased GFR was 88.30%, 41.49% and 31.91% respectively. Participants with significant albuminuria had fewer previous surgeries (p = 0.05), a longer waiting time for surgery (p = 0.02), enalapril usage (p = 0.04), pulmonary hypertension (p = 0.03), higher Hct z-score (p = 0.03) and lower platelet count (p = 0.001) compared with those without significant albuminuria. Using multivariate logistic regression analysis, waiting duration for surgery (p = 0.04), Hct >40% (p = 0.02), and platelet count <290,000/mm3 (p = 0.04) were predictive of microalbuminuria.

Conclusions

Cyanotic nephropathy can be detected in the first decade of life with the presentation of microalbuminuria. High Hct level and low platelet count were identified as a predictor of microalbuminuria, whereas early cardiac surgery decreased the risk of developing significant albuminuria.

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Acknowledgements

This study was funded by the Faculty of Medicine, Chiang Mai University. The authors would like to thank the pediatric cardiology nurses for assistance with urine collection, and the children and parents who volunteered to participate in this study.

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Authors and Affiliations

  1. Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand

    Nattaphorn Hongsawong & Wattana Chartapisak

  2. Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Prapimdaw Khamdee

  3. Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Suchaya Silvilairat

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  1. Nattaphorn Hongsawong
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  2. Prapimdaw Khamdee
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  3. Suchaya Silvilairat
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Correspondence to Nattaphorn Hongsawong.

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Written informed consent was obtained from all parents. The study has been approved by the Medical Ethics Committee of Chiang Mai University.

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The authors declare that there are no conflicts of interest regarding the publication of this paper.

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Hongsawong, N., Khamdee, P., Silvilairat, S. et al. Prevalence and associated factors of renal dysfunction and proteinuria in cyanotic congenital heart disease. Pediatr Nephrol 33, 493–501 (2018). https://doi.org/10.1007/s00467-017-3804-3

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  • DOI: https://doi.org/10.1007/s00467-017-3804-3

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