Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan.
Pediatr Nephrol. 2024 Feb;39(2):493-503. doi: 10.1007/s00467-023-06130-6. Epub 2023 Aug 30.
We validated the prevalence of albuminuria and its association with kidney function and hemodynamics in pre-school children who underwent surgery for congenital heart disease (CHD).
From 403 patients who had undergone surgery for CHD at least 6 months before pre-school and were admitted to our hospital between 2011 and 2015, 75 who underwent blood and urine tests and cardiac catheterization were included in this study. The urinary albumin-to-creatinine ratio (ACR) was quantified, and the relationship of ACR with physical and laboratory findings and hemodynamics assessed using cardiac catheterization was analyzed.
The study cohort was divided into three groups: Fontan group (n = 25), tetralogy of Fallot (TOF) group (n = 18), and control group (other biventricular CHDs; n = 32). The median age of patients was 5.9 years. ACR was higher in the Fontan group than in the TOF and control groups (median: 15.0 vs. 5.0 and 0.0 mg/g, p < 0.001). Moreover, albuminuria (ACR > 30 mg/g) was observed in 20.0% of Fontan patients, while ACR was associated with potential complicating factors of Fontan circulation: high central venous pressure, high mean pulmonary artery pressure, and worse than moderate atrioventricular regurgitation. ACR showed a moderate correlation with the cystatin C-based estimated glomerular filtration rate (r = - 0.725, p < 0.001).
Measurement of albuminuria in Fontan patients before they join elementary school is useful because it reflects kidney function and hemodynamic factors that can worsen their condition. Identification and management of patients with albuminuria may facilitate early therapeutic intervention for worsening Fontan factors, eventually delaying the deterioration of kidney function. A higher resolution version of the Graphical abstract is available as Supplementary information.
我们验证了在接受先天性心脏病 (CHD) 手术的学龄前儿童中蛋白尿的患病率及其与肾功能和血液动力学的关系。
从 2011 年至 2015 年期间在我院接受至少 6 个月 CHD 手术并入院的 403 名患者中，选择 75 名接受血液和尿液检查以及心导管检查的患者纳入本研究。定量测定尿白蛋白与肌酐比值 (ACR)，并分析 ACR 与体格检查和实验室检查结果以及心导管检查的血液动力学之间的关系。
研究队列分为三组：Fontan 组（n=25）、法洛四联症（TOF）组（n=18）和对照组（其他双心室 CHD；n=32）。患者的中位年龄为 5.9 岁。与 TOF 组和对照组相比，Fontan 组的 ACR 更高（中位数：15.0 比 5.0 和 0.0 mg/g，p<0.001）。此外，Fontan 组 20.0%的患者出现蛋白尿（ACR>30 mg/g），而 ACR 与 Fontan 循环的潜在并发症因素相关：中心静脉压高、平均肺动脉压高和中重度房室瓣反流。ACR 与基于半胱氨酸蛋白酶抑制剂的估计肾小球滤过率呈中度相关（r=-0.725，p<0.001）。
在 Fontan 患者上小学之前测量蛋白尿很有用，因为它反映了可能使病情恶化的肾功能和血液动力学因素。识别和管理蛋白尿患者可能有助于对 Fontan 恶化因素进行早期治疗干预，从而最终延缓肾功能恶化。更清晰的图文摘要版本可以作为补充信息获取。
