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      Exploring kidney biopsy findings in congenital heart diseases: Insights beyond cyanotic nephropathy

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          Abstract

          BACKGROUND

          The association between congenital heart disease and chronic kidney disease is well known. Various mechanisms of kidney damage associated with congenital heart disease have been established. The etiology of kidneydisease has commonly been considered to be secondary to focal segmental glomerulosclerosis (FSGS), however, this has only been demonstrated in case reports and not in observational or clinical trials.

          AIM

          To identify baseline and clinical characteristics, as well as the findings in kidney biopsies of patients with congenital heart disease in our hospital.

          METHODS

          This is a retrospective observational study conducted at the Nephrology Department of the National Institute of Cardiology “Ignacio Chávez”. All patients over 16 years old who underwent percutaneous kidney biopsy from January 2000 to January 2023 with congenital heart disease were included in the study.

          RESULTS

          Ten patients with congenital heart disease and kidney biopsy were found. The average age was 29.00 years ± 15.87 years with pre-biopsy proteinuria of 6193 mg/24 h ± 6165 mg/24 h. The most common congenital heart disease was Fallot’s tetralogy with 2 cases (20%) and ventricular septal defect with 2 (20%) cases. Among the 10 cases, one case of IgA nephropathy and one case of membranoproliferative glomerulonephritis associated with immune complexes were found, receiving specific treatment after histopathological diagnosis, delaying the initiation of kidney replacement therapy. Among remaining 8 cases (80%), one case of FSGS with perihilar variety was found, while the other 7 cases were non-specific FSGS.

          CONCLUSION

          Determining the cause of chronic kidney disease can help in delaying the need for kidney replacement therapy. In 2 out of 10 patients in our study, interventions were performed, and initiation of kidney replacement therapy was delayed. Prospective studies are needed to determine the usefulness of kidney biopsy in patients with congenital heart disease.

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          Most cited references25

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          Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study.

          To determine the incidence, severity, and risk factors of acute kidney injury in children undergoing cardiac surgery for congenital heart defects. Prospective observational multicenter cohort study. Three pediatric intensive care units at academic centers. Three hundred eleven children between the ages of 1 month and 18 yrs undergoing pediatric cardiac surgery. None. Acute kidney injury was defined as a ≥50% increase in serum creatinine from the preoperative value. Secondary outcomes were length of mechanical ventilation, length of intensive care unit and hospital stays, acute dialysis, and in-hospital mortality. The cohort had an average age of 3.8 yrs and was 45% women and mostly white (82%). One-third had prior cardiothoracic surgery, 91% of the surgeries were elective, and almost all patients required cardiopulmonary bypass. Acute kidney injury occurred in 42% (130 patients) within 3 days after surgery. Children ≥2 yrs old and <13 yrs old had a 72% lower likelihood of acute kidney injury (adjusted odds ratio: 0.28, 95% confidence interval: 0.16, 0.48), and patients 13 yrs and older had 70% lower likelihood of acute kidney injury (adjusted odds ratio: 0.30, 95% confidence interval: 0.10, 0.88) compared to patients <2 yrs old. Longer cardiopulmonary bypass time was linearly and independently associated with acute kidney injury. The development of acute kidney injury was independently associated with prolonged ventilation and with increased length of hospital stay. Acute kidney injury is common after pediatric cardiac surgery and is associated with prolonged mechanical ventilation and increased hospital stay. Cardiopulmonary bypass time and age were independently associated with acute kidney injury risk. Cardiopulmonary bypass time may be a marker for case complexity.
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            Progressive renal disease: the chronic hypoxia hypothesis.

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              Prevalence, predictors, and prognostic value of renal dysfunction in adults with congenital heart disease.

              Renal insufficiency in patients with ischemic heart disease and acquired heart failure is associated with higher mortality and morbidity. We studied the prevalence of renal dysfunction in adult patients with congenital heart disease (ACHD) and its relation to outcome. A total of 1102 adult patients with congenital heart disease (age 36.0+/-14.2 years) attending our institution between 1999 and 2006 had creatinine concentration measured. Glomerular filtration rate (GFR) was calculated with the Modification of Diet in Renal Disease equation. Patients were divided into groups of normal GFR (> or =90 mL . min(-1) . 1.73 m(-2)), mildly impaired GFR (60 to 89 mL . min(-1) . 1.73 m(-2)), and moderately/severely impaired GFR (<60 mL . min(-1) . 1.73 m(-2)). Survival was compared between GFR groups by Cox regression. Median follow-up was 4.1 years, during which 103 patients died. Renal dysfunction was mild in 41% of patients and moderate or severe in 9%. A decrease in GFR was more common among patients with Eisenmenger physiology, of whom 72% had reduced GFR (<90 mL . min(-1) . 1.73 m(-2), P<0.0001 compared with the remainder), and in 18%, this was moderate or severe (P=0.007). Renal dysfunction had a substantial impact on mortality (propensity score-weighted hazard ratio 3.25, 95% CI 1.54 to 6.86, P=0.002 for moderately or severely impaired versus normal GFR). Deranged physiology in adult patients with congenital heart disease is not limited to the heart but also affects the kidney. Mortality is 3-fold higher than normal in the 1 in 11 patients who have moderate or severe GFR reduction.
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                Author and article information

                Contributors
                Journal
                World J Nephrol
                WJN
                World Journal of Nephrology
                Baishideng Publishing Group Inc
                2220-6124
                25 March 2024
                25 March 2024
                : 13
                : 1
                : 88972
                Affiliations
                Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City 14080, Mexico
                Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City 14080, Mexico
                Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City 14080, Mexico
                Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City 14080, Mexico
                Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City 14080, Mexico
                Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City 14080, Mexico
                Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City 14080, Mexico
                Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City 14080, Mexico
                Congenital Heart Disease, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City 14080, Mexico
                Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City 14080, Mexico. salvadorlgil@ 123456gmail.com
                Author notes

                Author contributions: Juarez-Villa JD, Zepeda-Quiroz I, Toledo-Ramírez S, Gomez-Johnson VH, Pérez-Allende F, Garibay-Vega BR, Rodríguez Castellanos FE, Moguel-González B, Garcia-Cruz E, and Lopez-Gil S contributed to design of the study, data analysis, drafting and critical revision and editing, and final approval of the final version.

                Corresponding author: Salvador Lopez-Gil, MD, Associate Professor, Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chavez, 1 Juan Badiano, Mexico City 14080, Mexico. salvadorlgil@ 123456gmail.com

                Article
                jWJN.v13.i1.eid88972 88972
                10.5527/wjn.v13.i1.88972
                11000040
                38596269
                15804d8b-1542-4334-9359-8f2d6b0d98e2
                ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.

                This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                : 18 October 2023
                : 20 December 2023
                : 15 January 2024
                Categories
                Retrospective Study

                renal biopsy,congenital heart disease,chronic kidney disease,focal segmental glomerulosclerosis

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