Clinical Research Article | Published:

Altered in utero kidney development in newborns with congenital heart disease

Pediatric Research (2018) | Download Citation

Subjects

Abstract

Background

It is known that the heart is not the only organ affected in congenital heart disease (CHD); there is growth restriction of both the brain and the whole body. The protective mechanism of “the brain-sparing phenomenon” re-directs blood flow toward the growing brain in fetuses with CHD. We hypothesized that these changes would result in impaired fetal kidney growth.

Methods

The preoperative ultrasound measurements of kidney length were obtained retrospectively from 452 neonates requiring surgery for CHD. Percentiles were generated based on regression analysis of normative kidney length from three datasets according to both corrected gestational age and to birthweight.

Results

As a cohort, neonates with CHD have significantly enlarged kidneys, with a mean percentile ranging from 54.1–72.7 (p < 0.001), depending on the three normal population datasets used for comparison. The kidneys of neonates with left heart obstruction were consistently demonstrated to be greater than normal, unlike those with cyanotic heart disease which were shown to have either normal or enlarged kidneys, depending on the reference population used.

Conclusions

The kidneys of newborns with CHD are not reduced in size, and on average are larger than normal. The nature of this size discrepancy and its subsequent clinical significance is unknown.

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Acknowledgements

The Murdoch Children’s Research Institute is supported by the Victorian Government’s Operational Infrastructure Support Program. The Heart Research Group is supported by Big W and RCH 1000 of the Royal Children’s Hospital Foundation.

Author information

Affiliations

  1. Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia

    • Gemma B. Scholes
  2. Murdoch Children’s Research Institute, Melbourne, VIC, Australia

    • Diana Zannino
  3. Department of Nephrology, Royal Children’s Hospital, Melbourne, VIC, Australia

    • Joshua Y. Kausman
  4. Department of Cardiology, Royal Children’s Hospital, Melbourne, VIC, Australia

    • Michael M. H. Cheung

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Contributions

Substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data: G.B.S., D.Z., J.Y.K., and M.M.H.C. Drafting the article or revising it critically for important intellectual content: G.B.S., D.Z., J.Y.K., and M.M.H.C. Final approval of the version to be published: G.B.S., D.Z., J.Y.K., and M.M.H.C.

Competing interests

The authors declare no competing interests.

Corresponding author

Correspondence to Michael M. H. Cheung.

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DOI

https://doi.org/10.1038/s41390-018-0163-0