Renal Function in Children With Congenital Heart Defect
Abstract
Congenital heart defects (CHDs) are the most common type of congenital birth defect. The study aimed to assess the effect of CHD on renal involvement in comparison with the controls. This case control study conducted on 140 children with CHD and 70 healthy children in the years of 2022 and 2023. CHD diagnosis and based on the level of O2 saturation divided in CCHD and aCCHD. Potassium, sodium, hemoglobin in blood and creatinine and albumin in urine were measured in all participants. Glomerular filtration rate (GFR) is considered as a marker of renal involvement. The data analyzed with SPSS 22 and the level of significant considered equal or less than 0.05. Sex distribution was similar in groups of participants (X2=0.976, P=0.614). About 36.10% of the children with CCHD had renal involvement when this rate was 6.30% and 2.90% in aCCHD and the controls respectively (X2=36.154, P<0.001). Pairwise comparisons showed (C.C=0.350, P<0.001), (C.C=0.394, P<0.001), (C.C=0.082, P=0.317) for the pairs of CCHD-aCCHD, CCHD-Controls and aCCHD-Controls, respectively. The children with CCHD had odds ratio of 19.179 and the children with aCCHD had an odds ratio of 2.297 related to the reference (controls) group. The study concluded that children with cyanotic congenital heart disease (CCHD) exhibited a significantly higher risk of renal involvement compared to those with acyanotic congenital heart disease (aCCHD) and healthy controls. The chronic hypoxemia characteristic of CCHD may lead to compensatory erythrocytosis, resulting in elevated hemoglobin levels, which in turn may contribute to renal impairment through mechanisms such as increased blood viscosity, reduced renal perfusion, and glomerular injury.
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8. Tulloh RMR, Medrano-Lopez C, Checchia PA, Stapper C, Sumitomo N, Gorenflo M, et al. CHD and respiratory syncytial virus: global expert exchange recommendations. Cardiol Young 2017;27:1504–21.
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13. El Sayegh S, Ephrem G, Wish JB, Moe S, Lim K. Kidney disease and congenital heart disease: partnership for life. Front Physiol 2022;13:1022.
14. Gupte PA, Vaideeswar P, Kandalkar BM. Cyanotic nephropathy—a morphometric analysis. Congenit Heart Dis 2014;9:280-5.
15. Perloff JK, Latta H, Barsotti P. Pathogenesis of the glomerular abnormality in cyanotic congenital heart disease. Am J Cardiol 2000;86:1198-204.
16. Lee BJ. The kidney in congenital cyanotic heart disease. Methodist Debakey Cardiovasc J 2019;15:158–159.
17. Fang NW, Chen YC, Ou SH, Yin CH, Chen JS, Chiou YH, et al. Incidence and risk factors for chronic kidney disease in patients with congenital heart disease. Pediatr Nephrol 2021;36:3749–3756.
18. Mohamed MS, Rabeea MM, Abu Saif HS, Hammad KS. Assessment of renal functions in infants and children with congenital heart diseases. Egypt J Hosp Med 2019;74:219-25.
19. Rajani HS, Narayanappa D, Shetty M. Renal impairment in a child with cyanotic congenital heart disease. Prog Pediatr Cardiol 2018;48:105-6.
20. Hongsawong N, Khamdee P, Silvilairat S, Chartapisak W. Prevalence and associated factors of renal dysfunction and proteinuria in cyanotic congenital heart disease. Pediatr Nephrol 2018;33:493-501.
21. Amoozgar H, Basiratnia M, Ghasemi F. Renal function in children with cyanotic congenital heart disease: pre- and post-cardiac surgery evaluation. Iran J Pediatr 2014;24:81-6.
22. Zheng J, Yao Y, Han L, Xiao Y. Renal function and injury in infants and young children with congenital heart disease. Pediatr Nephrol 2013;28:99-104.
23. Talolena HW, Rahman MA, Soemyarso NA. Association analysis between cyanotic congenital heart disease and nephropathy in children. Dokkyo Med J 2022;1:85-91.
24. Isezuo KO, Sani UM, Waziri UM, Ilah BG, Jiya FB, Abdulrahman MB, et al. Microalbuminuria among children with congenital heart disease seen in Sokoto, North-Western Nigeria. Int J Contemp Pediatr 2021;8:414-419.
25. Amornchaicharoensuk Y, Werawatganon T, Tohsukhowong P, et al. Comparison of renal function between cyanotic and acyanotic congenital heart disease in children and adolescent. J Med Assoc Thai 2012;95:1501-1508.
26. Hamed DR. Renal dysfunction in children with congenital cyanotic heart disease. Zagazig Univ Med J 2023;29:38-43.
27. Maleki M, Ghaffari S, Ghaffari MR, Samadi M, Rastkar B, Maleki P, et al. Proteinuria in congenital heart disease: is it a real problem? J Cardiovasc Thorac Res 2013;3:17-21.
28. Li D, Niu Z, Huang Q, Sheng W, Wang T. A meta-analysis of the incidence rate of postoperative acute kidney injury in patients with congenital heart disease. BMC Nephrol 2020;21:1-10.
29. Parikh CR, Greenberg JH, McArthur E, Thiessen-Philbrook H, Everett AD, Wald R, et al. Incidence of ESKD and mortality among children with congenital heart disease after cardiac surgery. Clin J Am Soc Nephrol 2019;14:1450.
30. Madsen NL, Goldstein SL, Frøslev T, Christiansen CF, Olsen M. Cardiac surgery in patients with congenital heart disease is associated with acute kidney injury and the risk of chronic kidney disease. Kidney Int 2017;92:751-6.
31. Savedchuk S, Phachu D, Shankar M, Sparks MA, Harrison-Bernard LM. Targeting glomerular hemodynamics for kidney protection. Adv Kidney Dis Health 2023;30:71-84.
32. Morgan C, Al-Aklabi M, Guerra GG. Chronic kidney disease in congenital heart disease patients: a narrative review of evidence. Can J Kidney Health Dis 2015;2:63.
33. Shahid ASMSB, Alam T, Ackhter MM, Islam MZ, Parvin I, Shaima SN, et al. Factors associated with congenital heart disease in severely malnourished children under five and their outcomes at an urban hospital, Bangladesh. Children Basel 2021;9:1.
34. Zahoor F, Arshad MT, Liaqat S, Riaz S, Kumari V, Shahnawaz K, et al. Arrhythmias in children with congenital heart defects. Prof Med J 2023;30:219-23.
35. Shrimanker I, Bhattarai S. Electrolytes. In: StatPearls [Internet]. Treasure Island FL: StatPearls Publishing; 2024.
36. Clase CM, Carrero JJ, Ellison DH, Grams ME, Hemmelgarn BR, Jardine MJ, et al. Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a KDIGO controversies conference. Kidney Int 2020;97:42-61.
37. Nakhoul GN, Huang H, Arrigain S, Jolly SE, Schold JD, Nally JV Jr, et al. Serum potassium, end-stage renal disease and mortality in chronic kidney disease. Am J Nephrol 2015;41:456-63.
38. Sarnowski A, Gama RM, Dawson A, Mason H, Banerjee D. Hyperkalemia in chronic kidney disease: links, risks and management. Int J Nephrol Renovasc Dis 2022;15:215-28.
2. Song L, Wang Y, Wang H, Wang G, Ma N, Meng Q, et al. Clinical profile of congenital heart diseases detected in a tertiary hospital in China: a retrospective analysis. Front Cardiovasc Med 2023;10:1131383.
3. Liu Y, Chen S, Zuhlke L, Babu-Narayan SV, Black GC, Choy MK, et al. Global prevalence of congenital heart disease in school-age children: a meta-analysis and systematic review. BMC Cardiovasc Disord 2020;20:488.
4. Gillesén M, Fedchenko M, Giang KW, Dimopoulos K, Eriksson P, Dellborg M, et al. Chronic kidney disease in patients with congenital heart disease: a nationwide, register-based cohort study. Eur Heart J Open 2022;2:oeac055.
5. Mirzaei M, Mirzaei S, Sepahvand E, Rahmanian Koshkaki A, Kargar Jahromi M. Evaluation of complications of heart surgery in children with congenital heart disease at Dena Hospital of Shiraz. Glob J Health Sci 2015;8:33-8.
6. Morton SU, Quiat D, Seidman JG, Seidman CE. Genomic frontiers in congenital heart disease. Nat Rev Cardiol 2021;19:26–42.
7. Boryri T, Noori NM, Teimouri A, Sharafi F. The rate of addiction in parents of children with congenital heart disease compared with healthy children. Int J Pediatr 2017;5:4469-78.
8. Tulloh RMR, Medrano-Lopez C, Checchia PA, Stapper C, Sumitomo N, Gorenflo M, et al. CHD and respiratory syncytial virus: global expert exchange recommendations. Cardiol Young 2017;27:1504–21.
9. Mueller AS, McDonald DM, Singh HS, Ginns JN. Heart failure in adult congenital heart disease: tetralogy of Fallot. Heart Fail Rev 2020;25:583–98.
10. Krishna MR, Kumar RK. Diagnosis and management of critical congenital heart diseases in the newborn. Indian J Pediatr 2020;87:365–71.
11. Mandalenakis Z, Giang KW, Eriksson P, Liden H, Synnergren M, Wåhlander H, et al. Survival in children with congenital heart disease: have we reached a peak at 97%? J Am Heart Assoc 2020;9:e017704.
12. Kishore S, Kumar M, Kumar A, Gupta A, Chandan C, Anshuman A, et al. Clinical and echocardiographic profile of congenital heart diseases in the 0–12-year age group in a tertiary care medical institute in eastern India: a retrospective cross-sectional study. Cureus 2022;14:e26114.
13. El Sayegh S, Ephrem G, Wish JB, Moe S, Lim K. Kidney disease and congenital heart disease: partnership for life. Front Physiol 2022;13:1022.
14. Gupte PA, Vaideeswar P, Kandalkar BM. Cyanotic nephropathy—a morphometric analysis. Congenit Heart Dis 2014;9:280-5.
15. Perloff JK, Latta H, Barsotti P. Pathogenesis of the glomerular abnormality in cyanotic congenital heart disease. Am J Cardiol 2000;86:1198-204.
16. Lee BJ. The kidney in congenital cyanotic heart disease. Methodist Debakey Cardiovasc J 2019;15:158–159.
17. Fang NW, Chen YC, Ou SH, Yin CH, Chen JS, Chiou YH, et al. Incidence and risk factors for chronic kidney disease in patients with congenital heart disease. Pediatr Nephrol 2021;36:3749–3756.
18. Mohamed MS, Rabeea MM, Abu Saif HS, Hammad KS. Assessment of renal functions in infants and children with congenital heart diseases. Egypt J Hosp Med 2019;74:219-25.
19. Rajani HS, Narayanappa D, Shetty M. Renal impairment in a child with cyanotic congenital heart disease. Prog Pediatr Cardiol 2018;48:105-6.
20. Hongsawong N, Khamdee P, Silvilairat S, Chartapisak W. Prevalence and associated factors of renal dysfunction and proteinuria in cyanotic congenital heart disease. Pediatr Nephrol 2018;33:493-501.
21. Amoozgar H, Basiratnia M, Ghasemi F. Renal function in children with cyanotic congenital heart disease: pre- and post-cardiac surgery evaluation. Iran J Pediatr 2014;24:81-6.
22. Zheng J, Yao Y, Han L, Xiao Y. Renal function and injury in infants and young children with congenital heart disease. Pediatr Nephrol 2013;28:99-104.
23. Talolena HW, Rahman MA, Soemyarso NA. Association analysis between cyanotic congenital heart disease and nephropathy in children. Dokkyo Med J 2022;1:85-91.
24. Isezuo KO, Sani UM, Waziri UM, Ilah BG, Jiya FB, Abdulrahman MB, et al. Microalbuminuria among children with congenital heart disease seen in Sokoto, North-Western Nigeria. Int J Contemp Pediatr 2021;8:414-419.
25. Amornchaicharoensuk Y, Werawatganon T, Tohsukhowong P, et al. Comparison of renal function between cyanotic and acyanotic congenital heart disease in children and adolescent. J Med Assoc Thai 2012;95:1501-1508.
26. Hamed DR. Renal dysfunction in children with congenital cyanotic heart disease. Zagazig Univ Med J 2023;29:38-43.
27. Maleki M, Ghaffari S, Ghaffari MR, Samadi M, Rastkar B, Maleki P, et al. Proteinuria in congenital heart disease: is it a real problem? J Cardiovasc Thorac Res 2013;3:17-21.
28. Li D, Niu Z, Huang Q, Sheng W, Wang T. A meta-analysis of the incidence rate of postoperative acute kidney injury in patients with congenital heart disease. BMC Nephrol 2020;21:1-10.
29. Parikh CR, Greenberg JH, McArthur E, Thiessen-Philbrook H, Everett AD, Wald R, et al. Incidence of ESKD and mortality among children with congenital heart disease after cardiac surgery. Clin J Am Soc Nephrol 2019;14:1450.
30. Madsen NL, Goldstein SL, Frøslev T, Christiansen CF, Olsen M. Cardiac surgery in patients with congenital heart disease is associated with acute kidney injury and the risk of chronic kidney disease. Kidney Int 2017;92:751-6.
31. Savedchuk S, Phachu D, Shankar M, Sparks MA, Harrison-Bernard LM. Targeting glomerular hemodynamics for kidney protection. Adv Kidney Dis Health 2023;30:71-84.
32. Morgan C, Al-Aklabi M, Guerra GG. Chronic kidney disease in congenital heart disease patients: a narrative review of evidence. Can J Kidney Health Dis 2015;2:63.
33. Shahid ASMSB, Alam T, Ackhter MM, Islam MZ, Parvin I, Shaima SN, et al. Factors associated with congenital heart disease in severely malnourished children under five and their outcomes at an urban hospital, Bangladesh. Children Basel 2021;9:1.
34. Zahoor F, Arshad MT, Liaqat S, Riaz S, Kumari V, Shahnawaz K, et al. Arrhythmias in children with congenital heart defects. Prof Med J 2023;30:219-23.
35. Shrimanker I, Bhattarai S. Electrolytes. In: StatPearls [Internet]. Treasure Island FL: StatPearls Publishing; 2024.
36. Clase CM, Carrero JJ, Ellison DH, Grams ME, Hemmelgarn BR, Jardine MJ, et al. Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a KDIGO controversies conference. Kidney Int 2020;97:42-61.
37. Nakhoul GN, Huang H, Arrigain S, Jolly SE, Schold JD, Nally JV Jr, et al. Serum potassium, end-stage renal disease and mortality in chronic kidney disease. Am J Nephrol 2015;41:456-63.
38. Sarnowski A, Gama RM, Dawson A, Mason H, Banerjee D. Hyperkalemia in chronic kidney disease: links, risks and management. Int J Nephrol Renovasc Dis 2022;15:215-28.
| Files | ||
| Issue | Vol 64 No 4 (2026) | |
| Section | Original Articles | |
| Keywords | ||
| Congenital heart defect Children Renal involvement | ||
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How to Cite
1.
Noori NM, Sadeghi Bojd S, Teimouri A. Renal Function in Children With Congenital Heart Defect. Acta Med Iran. 2026;64(4):245-251.
