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Pre-operative renal volume predicts peak creatinine after congenital heart surgery in neonates

Published online by Cambridge University Press:  08 November 2013

J. Bryan Carmody*
Department of Pediatrics, Division of Nephrology, Eastern Virginia Medical School, Norfolk, Virginia, United States of America
Michael D. Seckeler
Section of Pediatric Cardiology, University of Arizona College of Medicine, Tucson, Arizona, United States of America
Cortney R. Ballengee
Department of Pediatrics, University of Virginia, Charlottesville, Virginia, United States of America
Mark Conaway
Department of Biostatistics and Epidemiology, University of Virginia, Charlottesville, Virginia, United States of America
K. Anitha Jayakumar
Sanger Heart and Vascular Institute and Levine Children's Hospital, Charlotte, North Carolina, United States of America
Jennifer R. Charlton
Department of Pediatrics, Division of Nephrology, University of Virginia, Charlottesville, Virginia, United States of America
Correspondence to: J. B. Carmody, MD, MPH, 601 Children's Lane, Norfolk, VA 23507, United States of America. (757) 668-7244; Fax: (757) 668-9814; E-mail:


Objective: Acute kidney injury is common in neonates following surgery for congenital heart disease. We conducted a retrospective analysis to determine whether neonates with smaller pre-operative renal volume were more likely to develop post-operative acute kidney injury. Design/Setting: We conducted a retrospective review of 72 neonates who underwent congenital heart surgery for any lesion other than patent ductus arteriosus at our institution from January 2007 to December 2011. Renal volume was calculated by ultrasound using the prolate ellipsoid formula. The presence and severity of post-operative acute kidney injury was determined both by measuring the peak serum creatinine in the first 7 days post-operatively and by using the Acute Kidney Injury Network scoring system. Results: Using a linear change point model, a threshold renal volume of 17 cm3 was identified. Below this threshold, there was an inverse linear relationship between renal volume and peak post-operative creatinine for all patients (p = 0.036) and the subgroup with a single morphologic right ventricle (p = 0.046). There was a non-significant trend towards more acute kidney injury using Acute Kidney Injury Network criteria in all neonates with renal volume ≤17 cm3 (p = 0.11) and in the subgroup with a single morphologic right ventricle (p = 0.17). Conclusions: Pre-operative renal volume ≤17 cm3 is associated with a higher peak post-operative creatinine and potentially greater risk for post-operative acute kidney injury for neonates undergoing congenital heart surgery. Neonates with a single right ventricle may be at higher risk.

Original Articles
Copyright © Cambridge University Press 2013 

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1. Sethi, SK, Goyal, D, Yadav, DK, et al. Predictors of acute kidney injury post-cardiopulmonary bypass in children. Clin Exp Nephrol 2011; 15: 529534.Google Scholar
2. Morgan, CJ, Zappitelli, M, Robertson, CM, et al. Risk factors for and outcomes of acute kidney injury in neonates undergoing complex cardiac surgery. J Pediatr 2013; 162: 120127.Google Scholar
3. Kist-van Holthe tot Echten, JE, Goedvolk, CA, Doornaar, MB, et al. Acute renal insufficiency and renal replacement therapy after pediatric cardiopulmonary bypass surgery. Pediatr Cardiol 2001; 22: 321326.Google Scholar
4. Picca, S, Principato, F, Mazzera, E, et al. Risks of acute renal failure after cardiopulmonary bypass surgery in children: a retrospective 10 year case control-study. Nephrol Dial Transplant 1995; 10: 630636.Google Scholar
5. Blinder, JJ, Goldstein, SL, Lee, VV, et al. Congenital heart surgery in infants: effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg 2012; 143: 368374.Google Scholar
6. Li, S, Krawczeski, CD, Zappitelli, M, et al. Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study. Crit Care Med 2011; 39: 14931499.Google Scholar
7. Pedersen, KR, Hjortdal, VE, Christensen, S, et al. Clinical outcome in children with acute renal failure treated with peritoneal dialysis after surgery for congenital heart disease. Kidney Int Suppl 2008; 73: S81S86.Google Scholar
8. Zappitelli, M, Bernier, PL, Saczkowski, RS, et al. A small post-operative rise in serum creatinine predicts acute kidney injury in children undergoing cardiac surgery. Kidney Int 2009; 76: 885892.Google Scholar
9. Chan, K, Ip, P, Chiu, CSW, Cheung, Y. Peritoneal dialysis after surgery for congenital heart disease in infants and young children. Ann Thorac Surg 2003; 76: 14431449.Google Scholar
10. Dittrich, S, Priesemann, M, Fisher, T, et al. Circulatory arrest and renal function in open heart surgery on infants. Pediatr Cardiol 2002; 23: 1519.Google Scholar
11. Hoy, WE, Douglas-Denton, RN, Hughson, MD, Cass, A, Johnson, K, Bertram, JF. A stereological study of glomerular number and volume: preliminary findings in a multiracial study of kidneys at autopsy. Kidney Int Suppl 2003; 63: S31S37.Google Scholar
12. Hoy, WE, Hughson, MD, Bertram, JF, Douglas-Denton, R, Amann, K. Nephron number, hypertension, renal disease, and renal failure. J Am Soc Nephrol 2005; 16: 25572564.Google Scholar
13. Keller, G, Zimmer, G, Mall, G, Ritz, E, Amann, K. Nephron number in patients with primary hypertension. N Engl J Med 2003; 348: 101108.Google Scholar
14. Luyckx, VA, Brenner, BM. The clinical importance of nephron mass. J Am Soc Nephrol 2010; 21: 898910.Google Scholar
15. Bertram, JF. Counting in the kidney. Kidney Int 2001; 59: 792796.Google Scholar
16. Nyengaard, JR, Bendtsen, TF. Glomerular number and size in relation to age, kidney weight, and body surface in normal man. Anat Rec 1992; 232: 194201.Google Scholar
17. Silver, LE, Decamps, PJ, Korst, LM, Platt, LD, Castro, LC. Intrauterine growth restriction is accompanied by decreased renal volume in the human fetus. Am J Obstet Gynecol 2003; 188: 13201325.Google Scholar
18. Ingelfinger, JR. Disparities in renal endowment: causes and consequences. Adv Chronic Kidney Dis 2008; 15: 107114.Google Scholar
19. Holloway, H, Jones, TB, Robinson, AE, Harpen, MD, Wiseman, HJ. Sonographic determination of renal volumes in normal neonates. Pediatr Radiol 1983; 13: 212214.Google Scholar
20. Dinkel, E, Ertel, M, Dittrich, M, Peters, H, Berres, M, Schulte-Wissermann, H. Kidney size in childhood. Sonographical growth charts for kidney length and volume. Pediatr Radiol 1985; 15: 3843.Google Scholar
21. Rosner, MH, Okusa, MD. Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol 2006; 1: 1932.Google Scholar
22. Bellomo, R, Auriemma, S, Fabbri, A, et al. The pathophysiology of cardiac surgery-associated acute kidney injury (CSA-AKI). Int J Artif Organs 2008; 31: 166178.Google Scholar
23. Jenkins, KJ, Gauvreau, K, Newburger, JW, Spray, TL, Moller, JH, Iezzoni, LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002; 123: 110118.Google Scholar
24. Mehta, RL, Kellum, JA, Shah, SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11: R31.Google Scholar
25. Haycock, GB, Schwartz, GJ, Wisotsky, DH. Geometric method for measuring body surface area: a height-weight formula validated in infants, children, and adults. J Pediatr 1978; 93: 6266.Google Scholar
26. Neter, J, Kutner, M, Nachtsheim, C, Wasserman, W. Qualitative predictor variables. In: Richard D (ed.). Applied Linear Statistical Models, 4th edn. Irwin Inc., Chicago, 1996, pp 474477.Google Scholar
27. Lassnigg, A, Schmidlin, D, Mouhieddine, M, et al. Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol 2004; 15: 15971605.Google Scholar
28. Ricci, Z, Luciano, R, Favia, I, et al. High-dose fenoldopam reduces postoperative neutrophil gelatinase-associated lipocaline and cystatin C levels in pediatric cardiac surgery. Crit Care 2011; 15: R160.Google Scholar
29. Devarajan, P. Update on mechanisms of ischemic acute kidney injury. J Am Soc Nephrol 2006; 17: 15031520.Google Scholar
30. Alkan, T, Akcevin, A, Turkoglu, H, et al. Postoperative prophylactic peritoneal dialysis in neonates and infants after complex congenital cardiac surgery. ASAIO J 2006; 52: 693697.Google Scholar
31. Dittrich, S, Dahnert, I, Vogel, M, et al. Peritoneal dialysis after infant open heart surgery: observations in 27 patients. Ann Thorac Surg 1999; 68: 160163.Google Scholar
32. Santos, CR, Branco, PQ, Gaspar, A, et al. Use of peritoneal dialysis after surgery for congenital heart disease in children. Perit Dial Int 2012; 32: 273279.Google Scholar
33. Parikh, CR, Devarajan, P, Zappitelli, M, et al. Postoperative biomarkers predict acute kidney injury and poor outcomes after pediatric cardiac surgery. J Am Soc Nephrol 2011; 22: 17371747.Google Scholar
34. Barron, DJ, Kilby, MD, Davies, B, Wright, JGC, Jones, TJ, Brawn, WJ. Hypoplastic left heart syndrome. Lancet 2009; 374: 551564.Google Scholar
35. Hui-Stickle, S, Brewer, ED, Goldstein, SL. Pediatric ARF epidemiology at a tertiary care center from 1999 to 2001. Am J Kidney Dis 2005; 45: 96101.Google Scholar
36. Barbu, D, Mert, I, Kruger, M, Bahado-Singh, RO. Evidence of fetal central nervous system injury in isolated congenital heart defects: microcephaly at birth. Am J Obstet Gynecol 2009; 201: e1e7.Google Scholar
37. Manzar, S, Nair, AK, Pai, MG, Al-Khusaiby, SM. Head size at birth in neonates with transposition of the great arteries and hypoplastic left heart syndrome. Saudi Med J 2005; 26: 453456.Google Scholar
38. Ronco, C, Haapio, M, House, AA, Anavekar, N, Bellomo, R. Cardiorenal syndrome. J Am Coll Cardiol 2008; 52: 15271539.Google Scholar
39. Bennett, M, Dent, CL, Ma, Q, et al. Urine NGAL predicts severity of acute kidney injury after cardiac surgery: a prospective study. Clin J Am Soc Nephrol 2008; 3: 665673.Google Scholar
40. Krawczeski, CD, Woo, JG, Wang, Y, Bennett, MR, Ma, Q, Devarajan, P. Neutrophil gelatinase-associated lipocalin concentrations predict development of acute kidney injury in neonates and children after cardiopulmonary bypass. J Pediatr 2011; 158: 10091015.Google Scholar
41. Sargent, MA, Long, G, Karmali, M, Cheng, SM. Interobserver variation in the sonographic estimation of renal volume in children. Pediatr Radiol 1997; 27: 663666.Google Scholar