Division of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Pediatr Nephrol. 2018 Mar;33(3):493-501. doi: 10.1007/s00467-017-3804-3. Epub 2017 Oct 2.
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.
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.
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/mm (p = 0.04) were predictive of microalbuminuria.
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.
紫绀性肾病（CN）在 30-50%先天性紫绀性心脏病（CCHD）患者中可见，影响肾小管和肾小球功能，导致蛋白尿和氮质血症。微量白蛋白尿是肾小球损伤的早期标志物，也是进行性肾病的独立预测因子。
进行了一项横断面研究。评估了 2015 年至 2016 年在清迈大学医院就诊的 116 名年龄在 1 个月至 15 岁的 CCHD 患者，其中 94 名患者入组。为了确定 CCHD 患者中显著白蛋白尿的患病率及相关因素，获取了基线特征、氧饱和度、手术、血红蛋白（Hb）、红细胞压积（Hct）、尿白蛋白、尿蛋白和肌酐。采用二元逻辑回归模型确定相关因素。
根据白蛋白尿和蛋白尿分期，儿童 CCHD 患者中 CN 的患病率分别为 58.51%和 92.55%。显著蛋白尿、显著白蛋白尿和肾小球滤过率降低的患病率分别为 88.30%、41.49%和 31.91%。与无显著白蛋白尿者相比，显著白蛋白尿者的既往手术次数较少（p=0.05），手术等待时间较长（p=0.02），使用依那普利（p=0.04），患有肺动脉高压（p=0.03），Hct z 评分较高（p=0.03），血小板计数较低（p=0.001）。使用多变量逻辑回归分析，手术等待时间（p=0.04）、Hct>40%（p=0.02）和血小板计数<290,000/mm（p=0.04）是微量白蛋白尿的预测因素。
紫绀性肾病可在生命的第一个十年内通过微量白蛋白尿表现出来。高 Hct 水平和低血小板计数被确定为微量白蛋白尿的预测因子，而早期心脏手术降低了发生显著白蛋白尿的风险。
