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      Chronic Kidney Disease in Adolescents after Surgery for Congenital Heart Disease


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          Background: The onset of chronic kidney disease (CKD) is an important prognostic factor in young adults with congenital heart disease (CHD). Although it is likely that CKD is manifest early in CHD patients, the prevalence among adolescents is still unknown. The National Kidney Foundation’s Kidney Disease Improving Global Outcomes guidelines 2012 recommend new equations for the estimated glomerular filtration rate (eGFR) and highlight the importance of albuminuria for CKD screening. The objective of the present study was to estimate the prevalence of CKD in CHD adolescents. Methods: This observational cross-sectional study included 115 patients aged 10–18 years attending the cardiologic outpatient clinic at our institution as a follow-up after cardiac surgery in infancy related to various CHDs. CKD assessment used the CKD criteria 2012, including eGFR equations based on serum creatinine and cystatin C, and measurement of albuminuria. Results: No patient had an eGFR <60 mL min<sup>–1</sup> 1.73 m<sup>–2</sup>. However, 28.7% of all patients (95% CI 20.7–37.9) had eGFR<sub></sub>between 60 and 89 mL min<sup>–1</sup> 1.73 m<sup>–2</sup> when estimated by the bedside Schwartz creatinine-based equation,<sup></sup>and 17.4% (95% CI 11.2–24.1) had eGFR<sub></sub>between 60 and 89 mL min<sup>–1</sup> 1.73 m<sup>–2</sup> when estimated by the Zappitelli equation, combining creatinine and cystatin C. Of all patients, 20.0% (95% CI 12.1–26.7) had orthostatic proteinuria, and none had persistent albuminuria. Conclusions: There was no evidence of CKD in the present population aged 10–18 years. The significance of an eGFR between 60 and 90 mL min<sup>–1</sup> 1.73 m<sup>–2</sup> is not concordant for this age range and requires further investigations.

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          Most cited references27

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          An estimated glomerular filtration rate equation for the full age spectrum.

          Glomerular filtration rate (GFR) is accepted as the best indicator of kidney function and is commonly estimated from serum creatinine (SCr)-based equations. Separate equations have been developed for children (Schwartz equation), younger and middle-age adults [Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation] and older adults [Berlin Initiative Study 1 (BIS1) equation], and these equations lack continuity with ageing. We developed and validated an equation for estimating the glomerular filtration rate that can be used across the full age spectrum (FAS).
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            Improved equations estimating GFR in children with chronic kidney disease using an immunonephelometric determination of cystatin C

            The Chronic Kidney Disease in Children study is a cohort of about 600 children with chronic kidney disease (CKD) in the United States and Canada. The independent variable for our observations was a measurement of glomerular filtration rate (GFR) by iohexol disappearance (iGFR) at the first two visits one year apart and during alternate years thereafter. In a previous report, we had developed GFR estimating equations utilizing serum creatinine, blood urea nitrogen, height, gender and cystatin C measured by an immunoturbidimetric method; however the correlation coefficient of cystatin C and GFR (-0.69) was less robust than expected. Therefore, 495 samples were re-assayed using immunonephelometry. The reciprocal of immunonephelometric cystatin C was as well correlated with iGFR as was height/serum creatinine (both 0.88). We developed a new GFR estimating equation using a random 2/3 of 965 person-visits and applied it to the remaining 1/3 as a validation data set. In the validation data set, the correlation of the estimated GFR with iGFR was 0.92 with high precision and no bias; 91% and 45% of eGFR values were within 30% and 10% of iGFR, respectively. This equation works well in children with CKD in a range of GFR from 15 to 75 ml/min per 1.73 m2. Further studies are needed to establish the applicability to children of normal stature and muscle mass, and higher GFR.
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              Microalbuminuria in the US population: third National Health and Nutrition Examination Survey.

              Microalbuminuria (MA) is associated with adverse health outcomes in diabetic and hypertensive adults. The prevalence and clinical significance of MA in nondiabetic populations is less clear. The purpose of this study was to generate national estimates of the prevalence of MA in the US population. Untimed urinary albumin concentrations (UACs) and creatinine concentrations were evaluated in a nationally representative sample of 22,244 participants aged 6 years and older. Persons with hematuria and menstruating or pregnant women were excluded from analysis. The percent prevalence of clinical proteinuria (UAC > or = 300 mg/L) was similar for males and females. However, the prevalence of MA (urinary albumin-creatinine ratio [ACR], 30 to 299 mg/g) was significantly lower in males (6.1%) compared with females (9.7%). MA prevalence was greater in children than young adults and increased continuously starting at 40 years of age. MA prevalence was greater in non-Hispanic blacks and Mexican Americans aged 40 to 79 years compared with similar-aged non-Hispanic whites. MA prevalence was 28.8% in persons with previously diagnosed diabetes, 16.0% in those with hypertension, and 5.1% in those without diabetes, hypertension, cardiovascular disease, or elevated serum creatinine levels. In adults aged 40+ years, after excluding persons with clinical proteinuria, albuminuria (defined as ACR > or = 30 mg/g) was independently associated with older age, non-Hispanic black and Mexican American ethnicity, diabetes, hypertension, and elevated serum creatinine concentration. MA is common, even among persons without diabetes or hypertension. Age, sex, race/ethnicity, and concomitant disease contribute to the variability of MA prevalence estimates. Copyright 2002 by the National Kidney Foundation, Inc.

                Author and article information

                Cardiorenal Med
                Cardiorenal Medicine
                S. Karger AG
                September 2020
                28 July 2020
                : 10
                : 5
                : 353-361
                [_a] aDepartment of Anesthesiology, Congenital Cardiac Unit, Marie Lannelongue Hospital, Le Plessis-Robinson, France
                [_b] bDepartment of Biochemistry, Lapeyronie Hospital, Montpellier, France
                [_c] cDepartment of Critical Care, Congenital Cardiac Unit, Marie Lannelongue Hospital, Le Plessis-Robinson, France
                [_d] dClinical Research Center, Lausanne University Hospital, Lausanne, Switzerland
                [_e] eUniversity of Lausanne, Lausanne, Switzerland
                [_f] fPediatric Cardiology, Necker-Enfants Malades Hospital, Paris, France
                [_g] gParis Descartes University, Paris, France
                Author notes
                *Mirela Bojan, Department of Anesthesiology, Congenital Cardiac Unit, Marie Lannelongue Hospital, 133, avenue de la Résistance, FR–92350 Le Plessis-Robinson (France), m.bojan@hml.fr
                508177 Cardiorenal Med 2020;10:353–361
                © 2020 S. Karger AG, Basel

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                : 14 January 2020
                : 20 April 2020
                Page count
                Figures: 1, Tables: 2, Pages: 9
                Research Article

                Cardiovascular Medicine,Nephrology
                Cardiac surgery,Chronic kidney disease,Congenital heart disease


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