الفهرس | Only 14 pages are availabe for public view |
Abstract The clinical course of congenital heart disease especially congenital cyanotic heart disease (CCHD) is often accompanied by the development of renal dysfunction. There is increasing number of patients with congenital heart diseases exposed to contrast media during cardiac catheterization procedures whether interventional or diagnostic. Contrast media use in all branches of medicine is reported to be the third most common cause of new onset renal failure in hospital patients. Our study included 19 patients (8 infants and 11 children) (age median=2.08, IQR=1-3.5 years) with CCHD. 26 patients (10 infants and 16 children) with congenital acyanotic heart diseases (median =2.33, IQR=0.75-8 years). 31 healthy controls (14 infants and 17 children) of matched age and sex for the comparison process. The patients underwent cardiac catheterization using the low osmolar contrast medium iopromide. All the patients were subjected to the following laboratory tests 24 hours before and 72 hours after cardiac catheterization: 1)Serum creatinine (sCr). 2)Corrected creatinine clearance (cCr.Cl). 3)Serum beta 2-microglobulin (s?2-MG). 4)Urinary retinol binding protein. 5)Fractional excretion of Na. 6)Urine/serum osmolality ratio. After statistical analysis to the previous data, we reached to the following results: Before cardiac catheterization: ” All infant and children patients when compared to control had normal kidney functions. ” uOSM/sOSM ratio showed significant reduction in cyanotic children when compared to control or acyanotic children. ” Although cCr.Cl correlated significantly with both s?2-MG and serum creatinine, yet the significance was much better with s?2-MG rather than sCr. After cardiac catheterization: ” All patients showed glomerular dysfunction in the form of significant reduction of cCr.Cl and significant increase in s?2-MG. ” Serum creatinine level showed no or weak significant change after cardiac catheterization among the studied groups. ” Corrected creatinine clearance was correlated significantly with s?2-MG and serum creatinine. Although cCr.Cl was correlated with both parameters, it is evident that its correlation is more significant with s?2-MG rather than with serum creatinine. ” All patients showed proximal and distal tubular dysfunction evidenced by significant increase of uRBP, FENa and significant reduction in uOSM/sOSM ratio. |