Renal Function in Fallot's Tetralogy

Abstract

Aperia, A., Bjarke, B., Broberger, 0. and Thoren, C. (Department of Paediatrics, Karolinska Institutet, S:t Giiran's Children's Hospital, Stockholm, Sweden).Renal Function in FaUot's Tetralogy. Acta Paediatr Scand, 63: 398, 1974.-Renal function was examined in 11 adults with Fallot's tetralogy. The following aspects of renal function were studied: GFR, PAH clearance, filtration fractions, the natriuretic response to an oral salt load and renal regulation of acid base balance. The GFR was found to be only moderately reduced while PAH clearance showed an almost 50% reduction in most cases studied. Consequently the filtration fraction was abnormally high. The natriuretic response to an oral salt load was generally low. The urinary sodium elimination rate was found to he independent of deviations in GFR and correlated inversely with the filtration fraction. The renal response to ammonium chloride induced acidosis WBS studied in 7 patients and was delayed in at least 3 of those. The pathological response was thought to he due to hypocapnic depression of renal HCO, reabsorption. It is suggested that this could contribute to the mild nonlactic acidosis onen present in congenital cyanotic heart disease.

Renal Function in Cyanotic Congenital Heart Disease

“…The low proximal tubular HCO – 3 threshold is probably caused by systemic hypervolemia, a known complication of erythrocytosis and fluid retention. Our findings on tubular sodium handling are in keeping with the data by Aperia et al [7]in subjects with CCHD and the experimental data of Schrier and Earley [23]in dogs. A rise in hematocrit causes proximal sodium retention which then augments the already existing expansion of the extracellular fluid compartment.…”

“…The distal tubule was not affected; the sodium and water handling in this part of the nephron was normal, and the distal tubular acidification was also not impaired according to the U PCO2 data obtained during the bicarbonate titration tests, the low U pH values, and the normal plasma potassium levels in the majority of the patients. The possibility of a proximal tubular defect in bicarbonate reabsorption in patients with CCHD was already raised by Aperia et al [7]as well as by Callis et al [21]and Rodriguez-Soriano et al [22]. The latter even described a patient with reversal of the acidosis after successful correction of the cardiac lesion.…”

“…Actually only three observations have achieved some attention: the chronic development of a rather typical glomerulopathy [1, 2, 3], the occurrence of mild to moderate proteinuria [4], and significant hyperuricemia [5]. Few physiological renal studies are available, certainly no recent ones [6, 7, 8, 9]. This is rather amazing, since it is well known that systemic circulatory changes greatly affect total renal and intrarenal blood flow [10, 11]which in due course leads to renal functional adaptations, many of which may have clinical significance.…”

Review article : The pathophysiology of nephrourological complications following cardiopulmonary bypass

“…In a series of 456 children undergoing CPB, 24 (5.3%) developed ARF. 8 The risk is highest in neonates, who had an incidence of 29% for ARF, compared to 3% for children greater than one year old The neonatal group is often very sick and CPB is undertaken as a life-saving measure.…”

“…23,24 Elevated renin levels are also sometimes found in congenital cyanotic heart disease, which may impair blood flow to the renal cortex. 24 The neonate with normally reduced flow to the cortex is at particular risk of renal cortical hypoperfusion and ischaemia following CPB.…”