Abstract
CHD is characterized by chronic hypoxemia and elevated hematocrit (HT). Both could affect renal hemodynamics and function. Renal clearance studies were performed before corrective surgery in 18 children presenting with CHD. Inulin clearance was normal (115 ± 5 ml/min × 1.73 m2) while PAH clearance was significantly depressed (410 ± 25). Filtration fraction was elevated to 29%. A negative correlation was observed between PAH clearance and HT (Y = 1355 − 17 ×, p<0.02) up to HT values of 60%. Free water clearance correlated with urine flow: the slope was similar in CHD and normal controls, thus reflecting normal Na transport in the distal tubule of CHD. Acidification studies demonstrated a state of proximal renal tubular acidosis with a bicarbonate threshold of 19.7 ± 0.6 mmol/l and a minimal urine pH of 5.15 ± 0.08. Urine PCO2 increased significantly above blood PCO2 during alkaline diuresis (ΔPCO2 = 29 mm Hg), thus demonstrating normal acidification by the distal tubule. It is concluded that chronic hypoxemia and/or elevated hematocrit present in CHD increase renal vascular resistance and decrease proximal bicarbonate reabsorption without affecting Na distal transport.
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Guignard, J., Burlet, A., Gautier, E. et al. RENAL FUNCTION IN CONGENITAL HEART DISEASE (CHD). Pediatr Res 14, 977 (1980). https://doi.org/10.1203/00006450-198008000-00025
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DOI: https://doi.org/10.1203/00006450-198008000-00025
