Amornchaicharoensuk Yupaporn, Werawatganon Thewarug, Tohsukhowong Piyarut, Boonla Chanchai, Gengsakul Aungkana, Tarunotai Thanakrit, Samankatiwat Piya, Treewatchareekorn Mala
Department ofPediatrics, Faculty ofMedicine, Vajira Hospital, Bangkok, Thailand.
J Med Assoc Thai. 2012 Dec;95(12):1501-8.
Glomerular and tubular dysfunction can be found in congenital heart disease (CHD) especially in older children and adults.
To evaluate the prevalence renal dysfunction and to compare glomerular and tubular function between cyanotic and acyanotic CHD in children and adolescent. Correlations among clinicalfactors, urinary glomerular and tubular markers for kidney injury were also determined.
Renal function was determined by estimated glomerular filtration rate, urine protein/creatinine, urine microalbumin/creatinine, FE Na+, FE Mg2, and urine NAG/creatinine in children and adolescent with CHD.
Forty-six patients, 15 cyanotic (group 1), and 31 acyanotic CHD (group 2), were studied. Only the differences of urine NAG/creatinine (median, 3.59 vs. 1.64 unit/gram creatinine; p = 0.008), FE Mg2+ (mean, 5.03 +/- 3.61% vs. 2.48 +/- 1.8%; p = 0.019), and urine protein/creatinine between the two groups were statistically significant (0.16 vs. 0.08; p = 0.001). No significant differences of clinical features, BUN, creatinine, eGFR, diastolic blood pressure, FE Na+, and urine microalbumin/creatinine were found between the two groups. Significantly higher prevalence ofabnormal biochemical markers in group 1 compared to those of group 2:86.6% vs. 43.38% (p = 0.02) for FE Mg2+; 46.6% vs. 9.67% (p = 0.008) for urine NAG/creatinine; 46.6% vs. 6.45% for significant proteinuria (p = 0.003); and 40% and 9.67% (p = 0.042) for microalbuminuria, respectively. The authors found moderate correlation between hemoglobin and functional class of the patients (r = 0.58) and highly negative correlation between oxygen saturation and functional class (r = -0.716). The relationships among other clinical or biochemical makers showed only low correlations.
Cyanotic CHD patients had more prevalence and higher abnormal biochemical markers for renal dysfunction than those of acyanotic CHD. Their urine protein/creatinine, FE Mg2 and urine NAG/creatinine were higher than those of acyanotic CHD. Only low correlation among biochemical markers was found
肾小球和肾小管功能障碍可见于先天性心脏病（CHD）患者，尤其是大龄儿童和成人。
评估儿童和青少年肾功能不全的患病率，并比较青紫型和非青紫型CHD患者的肾小球和肾小管功能。同时确定临床因素、尿中肾小球和肾小管损伤标志物之间的相关性。
通过估算肾小球滤过率、尿蛋白/肌酐、尿微量白蛋白/肌酐、滤过钠排泄分数（FE Na+）、滤过镁排泄分数（FE Mg2+）和尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）/肌酐，来测定CHD患儿和青少年的肾功能。
共研究了46例患者，其中15例为青紫型CHD（第1组），31例为非青紫型CHD（第2组）。两组间仅尿NAG/肌酐（中位数，3.59 vs. 1.64单位/克肌酐；p = 0.008）、FE Mg2+（均值，5.03±3.61% vs. 2.48±1.8%；p = 0.019）和尿蛋白/肌酐存在统计学显著差异（0.16 vs. 0.08；p = 0.001）。两组间临床特征、血尿素氮（BUN）、肌酐、估算肾小球滤过率（eGFR）、舒张压、FE Na+和尿微量白蛋白/肌酐无显著差异。第1组生化标志物异常的患病率显著高于第2组：FE Mg2+为86.6% vs. 43.38%（p = 0.02）；尿NAG/肌酐为46.6% vs. 9.67%（p = 0.008）；大量蛋白尿为46.6% vs. 6.45%（p = 0.003）；微量白蛋白尿分别为40%和9.67%（p = 0.042）。作者发现血红蛋白与患者心功能分级之间存在中度相关性（r = 0.58），氧饱和度与心功能分级之间存在高度负相关性（r = -0.716）。其他临床或生化指标之间的关系仅显示出低相关性。
青紫型CHD患者肾功能不全的患病率更高，生化标志物异常程度也高于非青紫型CHD患者。他们的尿蛋白/肌酐、FE Mg2+和尿NAG/肌酐高于非青紫型CHD患者。生化标志物之间仅发现低相关性
