Pediatric Patients Undergoing a Fontan Operation or with a High RACHS-1 Score Require Monitoring for Chronic Kidney Disease in Early Childhood

OBJECTIVES: This study aims to present the confirmed cases of SARS-CoV-2 infection in pediatric patients with chronic and acute kidney diseases admitted to a tertiary pediatric hospital. METHODS: Descriptive and retrospective observational study with all children hospitalized between March and June 2020 who had, simultaneously, SARS-CoV-2 infection and renal pathologies. Of this total of patients, those who had another underlying disease besides the renal disease were excluded. RESULTS: During the period, nine children with kidney disease were admitted to the hospital and had infection confirmed by the new coronavirus through positive RT-PCR. Regarding the underlying disease, seven had only kidney disease, three of whom had stage 5 chronic kidney disease; one, with stage 1 chronic kidney disease; one, with cortic-sensitive nephrotic syndrome; and two, with acute kidney injury. Two patients in this study had already undergone kidney transplantation, used immunosuppressants and had their doses reduced due to the infectious condition. Only one required oxygen therapy and transfer to the intensive care unit, but was not intubated and returned to the ward within 24 hours. CONCLUSIONS: According to the cases described, the pediatric population with kidney disease, including those using immunosuppressants due to acute transplant rejection, seems to evolve without severe COVID-19, therefore there is no great divergence in relation to the population of the same healthy age group.

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Pediatric problems of stratification of the severity of stages, cardiovascular complications and renal forecast of chronic kidney disease by NKF-K / DOQI (2002) and KDIGO (2012) classifications

Nephrology (Saint-Petersburg) ◽

10.36485/1561-6274-2021-25-3-9-19 ◽

2021 ◽

Vol 25 (3) ◽

pp. 9-19

Author(s):

N. D. Savenkova ◽

O. P. Grigoreva

Keyword(s):

Chronic Kidney Disease ◽

High Risk ◽

Kidney Disease ◽

Pediatric Patients ◽

Cardiovascular Complications ◽

High Risk Group ◽

Cardiovascular Pathology ◽

Cardiovascular Prognosis ◽

Renal Prognosis

Chronic kidney disease (CKD) in children is a global problem worldwide. The article discusses the problem of stratification of CKD severity according to the classifications of the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (NKF-K / DOQI) (2002) and Kidney Disease Improving Global Outcomes (KDIGO) (2012) in pediatric patients. There are limitations in assessing severity of CKD stages C1-5 according to NKF-K / DOQI (2002) and KDIGO (2012) in children under 2 years of age who have a low glomerular filtration rate in contrast to adults. The stratification of the severity of stages 1-5 of CKD, cardiovascular complications and renal prognosis in children and adolescents according to the classifications NKF-K / DOQI (2002) [3] and KDIGO (2012) [14] are discussed. In adult patients with CKD, there is a compelling case for identifying of C3a and C3b sub stages in 3 stages of CKD according to KDIGO (2012) was that renal and cardiovascular prognosis are different with GFR 45-59 ml/min/1.73 m 2and GFR 30-44 ml/min/1.73 m 2 . The prognosis of the risk of developing cardiovascular diseases and complications for stages C2-5 in accordance with the KDIGO classification (2012) in children and adults differ. As follows from the publications, children with CKD in the pre-dialysis stages C2-4 form a high-risk group, with C4-5 on dialysis a group of very high risk of complications associated with cardiovascular pathology. Cardiovascular complications account for more than 30 % of all deaths of pediatric patients with CKD C4-5 on dialysis. The arguments justifying the allocation of CKD stages C1-5 in children under 2 years of age in accordance with the classification of NKF-K/DOQI (2002) are presented.

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Abstract 10756: Chronic Kidney Disease in Long-term Survivors After Fontan Palliation

Circulation ◽

10.1161/circ.132.suppl_3.10756 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Sheena Sharma ◽

Rebecca L Ruebner ◽

Susan L Furth ◽

Kathryn M Dodds ◽

Jack Rychik ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Kidney Function ◽

Healthy Subjects ◽

Single Ventricle ◽

Fontan Operation ◽

Long Term Survivors ◽

Fontan Palliation ◽

Over Time

Background: The Fontan operation is a palliative procedure for children with congenital single ventricle heart disease. With advances in prenatal diagnosis and surgical techniques, more children are surviving into adulthood with unique cardiovascular physiology. Little is currently known about long-term kidney function in these patients. Hypothesis: We hypothesize that long-term survivors after Fontan palliation will have a higher prevalence of chronic kidney disease (CKD) compared to healthy controls. Methods: We performed a retrospective cohort study of subjects evaluated through the Single Ventricle Survivorship Program (SVSP) at the Children’s Hospital of Philadelphia between July 1, 2010 and December 5, 2014 and healthy children similar in sex and age. The primary outcome was CKD, defined as eGFR <90 ml/min/1.73m2 calculated with age-appropriate estimating equations using creatinine and cystatin C. Secondary outcomes included proteinuria and hyperparathyroidism. Results: The Fontan cohort included 68 subjects with mean age of 13.9 years (SD 5.8) at SVSP visit who were 11.2 years (SD 5.7) from Fontan operation. The healthy cohort included 70 patients with mean age of 15.9 years (SD 3.9). Mean eGFR was 102.6 versus 101.9ml/min/1.73m2 (p=0.89) in pediatric Fontan versus healthy subjects using the complete CKiD equation, and 128.5 versus 129.7ml/min/1.73m2 (p=0.56) in adult Fontan versus healthy subjects using the CKD-EPI creatinine and cystatin formula. 10% of Fontan subjects had an eGFR<90 ml/min/1.73m2. Mean intact parathyroid hormone level was higher at 68.0pg/mL (SD 35.4) in the Fontan group compared to 26.0pg/mL (SD 13.6) in the healthy group. Proteinuria was found within 34% of the Fontan group compared to 4.6% within the control group. Conclusion: We found that 10% of subjects have eGFR <90ml/min/1.73m2 after Fontan palliation which would indicate CKD if this remained persistent over time. Although the majority of the cohort had normal kidney function by eGFR, we found a higher proportion with proteinuria and increased parathyroid hormone levels which may indicate early kidney disease. Future studies will focus on evaluating changes in kidney function over time in long-term survivors after Fontan palliation.

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