Screening of pediatric patients with congenital anomalies of the kidney and urinary tract for associated congenital heart disease in a tertiary care setting.

BACKGROUND

Congenital anomalies of the kidney and urinary tract (CAKUT) are among the most common birth defects and represent a leading cause of chronic kidney disease (CKD) in children. Congenital heart disease (CHD) is the most frequent severe congenital malformation worldwide. Given the shared mesodermal embryologic origin of both the renal and cardiovascular systems, an association between CAKUT and CHD has been proposed. We aimed to screen pediatric patients diagnosed with CAKUT for the presence of associated CHD.

METHODS

This cross-sectional analytical study included 300 pediatric patients with CAKUT. Demographic data, type of CAKUT and kidney function status were collected. All patients underwent cardiac evaluation and echocardiography to detect structural heart defects and assess cardiac function. CAKUT types and their association with CHD were analyzed.

RESULTS

The mean age of the cohort was 6.42 years, with a male predominance (68.7%). CHD was detected in 7% of patients, with atrial septal defect (33%) and ventricular septal defect (23%) being the most frequent lesions. 28.5% of these patients with CHD needed surgical intervention. The most common CAKUT subtype was vesicoureteral reflux (27.7%), and it was the most common CAKUT subtype associated with CHD. Fractional shortening impairment was strongly associated with advanced CKD.

CONCLUSIONS

The coexistence of CHD among children with CAKUT could emphasize the need for cardiac evaluation and consider the echocardiographic screening in this population. Moreover, the observed link between advanced CKD stage and cardiac dysfunction supports the necessity of integrated nephro-cardiac care in these patients.