Amoozgar Hamid, Basiratnia Mitra, Ghasemi Fatemeh
Department of Pediatric Cardiology, Nemazee Hospital.
Shiraz Nephrology and Urology Research Center.
Iran J Pediatr. 2014 Feb;24(1):81-6. Epub 2014 Jan 25.
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.
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).
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.
紫绀型先天性心脏病（CCHD）是一系列心脏异常疾病，长期以来一直被认为是肾病的潜在病因。关于CCHD患者在心脏矫正手术前后肾功能损害的报道较少。本研究的目的是评估心脏手术前后肾功能不全的患病率以及一些危险因素对最终肾脏结局的影响。
本研究纳入了30名在过去6个月内接受过心脏矫正手术的CCHD患儿。术前所有数据均从病历中收集。术后数据包括血液和即时尿样，在随访期间同时采集用于血常规、肌酐和尿酸检测，同时收集24小时尿液用于检测微量白蛋白和肌酐。比较术前和术后参数，以研究心脏手术对肾功能的影响。结果：术前和术后的肾小球滤过率（GFR）无显著差异。最终GFR与术前和术后年龄显著负相关（P = 0.008，r = -0.48；P = 0.03，r = -0.38）。3例（10%）患者出现微量白蛋白尿。10岁以上儿童微量白蛋白尿的患病率为30%。微量白蛋白尿与年龄、GFR和血细胞比容之间无关联（分别为P = 0.1、P = 0.3、P = 0.3）。术前血细胞比容>45的患者与血细胞比容<45的儿童相比，最终GFR显著降低（83.7±6.5 vs 111.1±0.2，P = 0.001）。尿酸排泄分数（FEua）的平均排泄量为8.21±4.75。术前血细胞比容与FEua呈负相关（P = 0.01，r = -0.44）。FEua与年龄、血清尿酸和GFR之间无关系（P = 0.7、P = 0.4、P = 0.2）。
CCHD患儿发生肾损伤的风险增加，这更多地与紫绀持续时间和较高的血细胞比容水平有关。为降低风险，建议尽早进行心脏矫正手术以改善肾功能并防止更多的肾损害。
