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8 authors, including:
Yupaporn Amornchaicharoensuk
Chanchai Boonla
Chulalongkorn University
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Piya Samankatiwat
Ramathibodi Hospital
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Correspondence to:
Amornchaicharoensuk Y, Department of Pediatrics, Faculty of
Medicine, Vajira Hospital, 681 Samsen Road, Dusit, Bangkok 10300,
Thailand.
Phone: 0-2244-3162
E-mail: yupa63@yahoo.com
FE Na
Statistical analysis
Results were carried out using SPSS version
13.0 statistical package. Data were presented as
mean SD for those with normal distribution and
median (min-max) for non-normal distribution.
Comparisons between groups were performed using
independent t-test for parametric data whereas the
nonparametric data were analyzed by Mann-Whitney
U test. Categorical data were compared by Chi-square
test or Fishers exact test for non-parametric data.
Correlation coefficients among clinical factors (age,
Hb, O2 saturation), tubular urinary markers (urine
NAG/creatinine, FE Mg2+, FE Na+), and glomerular
urinary markers (urine protein/creatinine, urine
microalbumin/creatinine) were analyzed by Spearmans
rho correlation. Correlation coefficient (r) 0.7 to 0.9
was defined as high correlation, 0.5 to 0.7 as moderate
correlation, and 0.3 to 0.5 as low correlation(19). P-value
of < 0.05 was regarded as significant.
Results
Forty-six patients with CHD were enrolled
into the present study. Group 1 comprised of 15 cyanotic
CHD while group 2 were 31 acyanotic CHD patients.
There were no statistically significant differences
between the two groups regarding age, bodyweight,
height, diastolic blood pressure, BUN, serum creatinine,
estimated glomerular filtration rate, spot urine microalbumin/creatinine, and FE Na+ (Table 1, 2).
The present study found statistically
significant differences in three biochemical markers
between group 1 and group 2: 3.59 (0-32) vs. 1.64
(0-29.3) unit/gram creatinine for urine NAG/creatinine
(p = 0.008); 5.03 3.61% vs. 2.48 1.8% for FE Mg2+
(p = 0.019); and 0.16 (0.075-10.78) vs. 0.08 (0.02-0.5)
for urine protein/creatinine (p = 0.001). No significant
differences of FE Na + and urine microalbumin/
creatinine between the two groups were found:
0.86 0.75% vs. 0.92 0.63% (p = 0.780) and 20.6
(0.22-5,102.75) vs. 10.45 (1.4-206.25) milligram/gram
(p = 0.073), respectively. The comparison of these
markers is shown in Table 2.
Significantly higher prevalence of abnormal
biochemical markers in group 1 compared to those of
group 2: 86.6% vs. 43.38% (p = 0.02) for abnormal
FE Mg2+, 46.6% vs. 9.67% (p = 0.008) for abnormal
urine NAG/cr, 46.6% vs. 6.45% (p = 0.003) for
significant proteinuria, and 40% and 9.67% (p = 0.042)
9.33 5.56
p-value
7.00 3.50
0.153
25.50 15.37
21.70 8.54
0.387
119.80 27.00
116.90 18.40
0.666
94.70 9.97
106.90 16.31
0.011*
58.87 10.46
57.35 10.10
0.640
Hemoglobin (g/dl)
17.88 4.43
12.01 1.23
0.000*
77.00 11.73
97.00 2.32
0.000*
9 (60)
4 (12.9)
0.001**
16.58 11.50
11.81 3.10
0.135
0.68 0.32
0.61 0.18
0.363
2 (13.3)
9 (60)
3 (20)
1 (6.66)
30 (96.77)
1 (3.22)
0
0
0.000**
Functional class
Class I
Class II
Class III
Class IV
1503
Discussion
With emerging technologies of therapeutic
intervention for CHD in children, these patients can
have a long life span. Any long-term complications
from CHD should be prevented or well attended to
minimize the severity. Regarding an impairment of
renal function in CHD, a detection of early renal
dysfunction is important. The patients renal reserve
function will be useful for the physicians to be cautious
especially when a use of any nephrotoxic agents is
considered. For the patients who already have
glomerular or tubular dysfunction, they should be
closely followed up and be monitored regularly.
Intervention by medication and education the
patients to avoid nephrotoxic substances would slow
progression of renal deterioration.
The present study demonstrated both
glomerular and tubular dysfunctions among children
and adolescents aged 1 to 18 years old who had
cyanotic (group 1) and acyanotic CHD (group 2).
p-value
117.04 37.18
113.98 34.05
0.783
0.86 0.75
0.92 0.63
0.780
5.03 3.61
2.48 1.8
0.019*
3.59 (0-32)
1.64 (0-29.3)
0.008**
Urine protein/creatinine
0.16 (0.075-10.78)
0.001**
20.60 (0.22-5,102.75)
10.45 (1.4-206.25)
0.073
Acyanotic CHD
(n = 31)
p-value
11 (73.33)
3 (20)
1 (6.66)
24 (77.4)
7 (22.5)
0
0.503
7 (46.6)
2 (6.45)
0.003*
6 (40)
3 (9.67)
0.042*
7 (46.6)
3 (9.67)
0.008*
6 (40)
12 (38.71)
0.585
13 (86.6)
15 (48.38)
0.020*
1504
0.295*
-0.436**
0.285
0.305*
-0.032
0.095
0.273
0.484**
1
0.022
0.239
-0.475**
0.474**
0.366*
0.141
0.373*
0.375*
1
0.484**
0.135
0.037
-0.354**
0.395*
0.138
-0.042
0.255
1
0.375*
0.273
0.184
0.10
-0.334*
0.34*
0.347**
0.308**
1
0.255
0.373*
0.095
-0.109
0.499** 0.065 0.167
-0.448** -0.064 0.007
0.580** 0.176 0.026
1
0.019 0.148
0.148
0.020 1
0.347** -0.109 0.308**
0.138
0.184 -0.042
0.366*
0.135 0.141
0.305*
0.022 0.022
0.019
1
0.020
0.367**
-0.716**
1
0.580**
0.026
0.340*
0.395*
0.474**
0.285
0.176
-0.167
1
-0.716**
-0.448**
0.007
-0.334
-0.354**
-0.475**
-0.436**
-0.064
1
-0.167
0.367**
0.499**
0.167
0.100
0.037
0.239
0.295*
0.065
Age (y)
Oxygen saturation (%)
Functional class
Hb (g/dl)
FE Na+ (> 1%)
FE Mg2+ (> 2.2%)
Urine NAG/cr
Urine protein/cr
Urine microalbumin/cr
eGFR
FE Mg
Urine NAG/cr Urine protein/cr Urine microalbumin/cr
> 2.2 (%) > 5.2 U/gram cr
> 0.2
> 30 g/mg
Glomerular function
FE Na
> 1 (%)
2+
Tubular function
eGFR
Functional Hb (g/dl)
class
Oxygen
sat (%)
Age (y)
Table 4. Correlation coefficient (r) between age, oxygen saturation, hemoglobin, urine glomerular and tubular marker in congenital heart disease
8.
9.
10.
11.
12.
13.
14.
1507
, , , , ,
, ,
: (glomerular function)
: (glomerular function)
glomerular marker tubular marker
: 46 15 ( 1)
31 ( 2) Urine NAG/creatinine (median, 3.59
1.64 U/gram creatinine; p = 0.008), FE Mg2+ (mean, 5.03 3.61% 2.48 1.8%; p = 0.019), urine
protein/creatinine (median, 0.16 0.08; p = 0.001) 2
, BUN, creatinine, eGFR, FE Na+ urine microalbumin/creatinine
2 1 2
: FE Mg2+: 86.6% 43.38% (p = 0.02), urine NAG/creatinine: 46.6% 9.67%
(p = 0.008), significant proteinuria: 46.6% 6.45% (p = 0.003), microalbuminuria: 40% 9.67% (p = 0.042)
hemoglobin functional class
(r = 0.58) oxygen saturation functional class (r = -0.716)
:
urine protein/creatinine, FE Mg2+ Urine NAG/creatinine
1508