Martínez-Quintana Efrén, Barreto-Martín Alejandro, Estupiñán-León Hiurma, Rojas-Brito Ana Beatriz, Déniz-Déniz Liuva, Rodríguez-González Fayna
Cardiology Service, Complejo Hospitalario Universitario Insular-Materno Infantil Las Palmas de Gran Canaria, Spain.
Medical and Surgical Sciences Department, Faculty of Health Sciences, Universidad de Las Palmas de Gran Canaria Las Palmas de Gran Canaria, Spain.
Am J Cardiovasc Dis. 2021 Feb 15;11(1):46-52. eCollection 2021.
Congenital heart disease (CHD) patients, especially cyanotic ones, usually have renal function impairment. However, little information exists in non-cyanotic CHD patients. The objective of this study is to determine renal failure in non-hypoxemic CHD patients by measuring the amount of protein and albumin released in urine over a 24-hour period and determining the glomerular filtration rate (GFR). Prospective study of consecutive outpatient non-hypoxemic CHD patients followed up in a single tertiary referral hospital. Demographic, clinical, blood test and 24-hour urine collection were recorded. 264 CHD patients, 22 (18-343) years old and 160 (61%) males, were followed up during 9.2 (5.9-11.1) years. 137 (52%), 96 (36%) and 31 (18%) CHD patients had mild, moderate, and great anatomical CHD defects. 44 (17%) and 32 (12%) CHD patients showed proteinuria (≥ 150 mg/24 hours) and albuminuria (> 30 mg/24 hours) respectively. 35 out of 44 (79%) CHD patients with proteinuria (≥ 150 mg/24 hours) showed normal to mild albuminuria levels (< 30 mg/24 hours). Variables associated with proteinuria were male sex, body mass index, auricular fibrillation/flutter, arterial hypertension, diabetes mellitus and being under angiotensin-converting enzyme (ACE) inhibitor and an angiotensin receptor blocker (ARB), loop diuretics or anti-aldosterone treatment. Major adverse cardiovascular events (MACE), defined as cardiovascular and non-cardiovascular deaths, stroke, myocardial infarction and heart failure requiring hospitalization, occurred in 16 (6%) patients during the follow up time. Multivariate Cox regression analysis showed that older patients, patients with a great CHD complexity and patients with proteinuria [6.99 (1.90-24.74), P=0.003] had a significant higher risk of MACE. Proteinuria is frequent among non-hypoxemic CHD patients and occurs mostly in those with a GFR above 60 ml/min/1.73 m and normal to mild albuminuria levels. Having proteinuria, but not albuminuria, was independently associated with a worse outcome.
先天性心脏病（CHD）患者，尤其是青紫型患者，通常存在肾功能损害。然而，关于非青紫型CHD患者的相关信息较少。本研究的目的是通过测量24小时内尿液中蛋白质和白蛋白的释放量并测定肾小球滤过率（GFR），来确定非低氧血症CHD患者是否存在肾衰竭。对一家三级转诊医院连续随访的门诊非低氧血症CHD患者进行前瞻性研究。记录人口统计学、临床、血液检查和24小时尿液收集情况。264例CHD患者，年龄22（18 - 343）岁，男性160例（61%），随访时间为9.2（5.9 - 11.1）年。137例（52%）、96例（36%）和31例（18%）CHD患者分别有轻度、中度和重度先天性心脏病解剖缺陷。44例（17%）和32例（12%）CHD患者分别出现蛋白尿（≥150 mg/24小时）和白蛋白尿（> 30 mg/24小时）。44例蛋白尿（≥150 mg/24小时）的CHD患者中有35例（79%）白蛋白尿水平正常至轻度（< 30 mg/24小时）。与蛋白尿相关的变量包括男性、体重指数、心房颤动/扑动、动脉高血压、糖尿病以及正在接受血管紧张素转换酶（ACE）抑制剂、血管紧张素受体阻滞剂（ARB）、袢利尿剂或抗醛固酮治疗。主要不良心血管事件（MACE）定义为心血管和非心血管死亡、中风、心肌梗死以及需要住院治疗的心力衰竭，在随访期间16例（6%）患者中发生。多变量Cox回归分析显示，年龄较大的患者、CHD复杂性高的患者以及有蛋白尿的患者[6.99（1.90 - 24.74），P = 0.003]发生MACE的风险显著更高。蛋白尿在非低氧血症CHD患者中很常见，且大多发生在GFR高于60 ml/min/1.73 m²且白蛋白尿水平正常至轻度的患者中。存在蛋白尿而非白蛋白尿与较差的预后独立相关。
