Nephropathy is a recognised complication of long-standing congenital cyanotic heart disease (CCHD). Both renal tubular and glomerular dysfunction, manifested by low GFR, proteinuria and renal tubular acidosis, can occur. Chronic hypoxaemia and reduced renal blood flow due to polycythamia, form the pathophysiological basis of renal dysfunction in CCHD patients. Low threshold for bicarbonate in the proximal renal tubules has been described as the mechanism for development of hyperchloraemic acidosis in such patients. However as renal tubular damage is likely to be global, hyporeninaemic hypoaldosteronism could also play its role.
The association of renal tubular acidosis and cyanotic congenital heart disease
Vida et al. J Thorac Cardiovasc Surg.2005; 130: 1466-1467.
I hope this would be a useful learning point to some of you.
regards
Mohammad
A 65-year-old woman, with Fallot’s tetralogy, was admitted because of dizziness and collapse. Remarkably she was not on any medications. The following biochemical results were obtained:
Urea + 7.9
Creatinine 101
Sodium 143
Potassium 5.2
Bicarb - 12.0
Chloride + 125
Anion gap 11.2
eGFR 51
As ever, comments are welcome.
regards
Mohammad
Dr. M A Al-Jubouri
Consultant Chemical Pathologist
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