Renal Involvements in Children with Congenital Heart Disease

Abstract

Background: Renal involvement is a documented complication of cyanotic congenital heart disease (CCHD) in adults but is uncommonly seen in children. Objectives: This study aimed to assess changes in renal involvement parameters in children with congenital heart disease (CHD) compared with controls. Methods: This case-control study was conducted on 160 children, including 110 with CHD and 50 controls, after applying exclusion criteria. The children with CHD were categorized into acyanotic congenital heart disease (aCCHD, 50 children) and CCHD (60 children) based on arterial blood gas analysis. Blood samples (3 mL) were collected from participants, and blood urea nitrogen (BUN), creatinine, and uric acid levels were measured using an ELISA technique. A random urine sample was used to measure microalbuminuria. After recording these values, the estimated glomerular filtration rate (eGFR) and microalbumin/creatinine ratio were calculated. Data were analyzed using SPSS version 22, with a significance level of P ≤ 0.05. Results: Height and weight were significantly lower in children with CCHD across all age groups (P = 0.05). Microalbuminuria was higher in CCHD (14.51 ± 7.81 mg/mg) compared to aCCHD (10.20 ± 1.95 mg/mg) and controls (10.31 ± 1.73 mg/mg) (P = 0.015). Uric acid levels were elevated in CCHD (5.26 ± 1.35 mg/dL) versus aCCHD (3.48 ± 0.8 mg/dL) and controls (3.62 ± 0.77 mg/dL) (P < 0.001). The albumin/creatinine ratio was increased in children with CCHD (26.59 ± 14.15) compared to those with aCCHD (20.57 ± 6.26) and controls (20.47 ± 5.63) (P = 0.023). The eGFR was lower in CCHD (85.15 ± 19 mL/min/1.73 m2) compared to aCCHD (102.61 ± 14.91 mL/min/1.73 m2) and controls (101.64 ± 18.38 mL/min/1.73 m2) (P < 0.001). Age-specific analysis showed significant reductions in glomerular filtration rate (GFR) and increases in creatinine and uric acid levels in children with CCHD compared to other groups across all age categories (P < 0.001). Pairwise comparisons confirmed significant group differences in renal involvement markers and growth parameters. Conclusions: This study highlights significant renal dysfunction in children with CHD, particularly those with CCHD. Children with CCHD exhibited lower growth parameters, including height and weight, as well as increased markers of renal involvement, such as microalbuminuria, uric acid levels, and albumin/creatinine ratios, compared to both aCCHD children and healthy controls. Additionally, the eGFR was notably decreased in CCHD children, indicating compromised kidney function.