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Cardiac function and structure in patients with chronic renal failure
K Schärer1, K G Schmidt, M Soergel
1Division of Pediatric Nephrology, University Children's Hospital, Im Neuenheimer Feld 150, D-69120 Heidelberg, Germany.
Insights
Cardiac issues in children with chronic renal failure (CRF) and after transplantation (TX) are significant. Early detection and management of heart disease in these pediatric patients are crucial for improving long-term cardiovascular outcomes.
Area of Science:
- Pediatric Nephrology
- Cardiology
- Renal Transplantation
Background:
- Long-term cardiac consequences in pediatric chronic renal failure (CRF) and post-transplant (TX) patients remain unclear.
- Cardiovascular disease is a major cause of morbidity and mortality in adults with end-stage renal disease (ESRD), suggesting similar risks for pediatric patients.
- Understanding cardiac alterations in children with CRF and after TX is vital for predicting long-term health outcomes.
Purpose of the Study:
- To review the clinical manifestations, pathophysiology, cardiac function, structure, and management of heart disease in pediatric patients with CRF and following renal transplantation.
- To highlight the importance of early detection and monitoring of cardiac complications in this vulnerable population.
Main Methods:
- Echocardiography and Doppler ultrasonography are utilized to assess cardiac function and structure.
- Analysis includes differentiation of hypercirculation, systolic and diastolic left ventricular (LV) dysfunction, LV size, and myocardial mass.
- Review of existing literature and experimental studies on cardiac changes in pediatric CRF and post-TX patients.
Main Results:
- Left ventricular (LV) hypertrophy is prevalent in approximately half of pediatric patients with ESRD and after TX, serving as an early prognostic marker.
- LV hypertrophy may be reversible with management of hypertension, hypervolemia, and anemia.
- Uremia is associated with intrinsic cardiac structural abnormalities, including cardiomyocyte hypertrophy, interstitial fibrosis, and vascular changes, independent of hemodynamic factors.
Conclusions:
- Cardiac complications in children with CRF and after TX require regular clinical and echocardiographic surveillance.
- Proactive management of cardiac issues can help mitigate future cardiovascular morbidity.
- Early identification and treatment of cardiac alterations are essential for improving the long-term prognosis of pediatric renal disease patients.
Abstract:
The long-term consequences of cardiac alterations in children with chronic renal failure (CRF) and after renal transplantation (TX) are largely unknown. Studies in adults with end-stage renal disease (ESRD) assume that the fate of many pediatric patients is determined by a high cardiovascular morbidity and mortality. This review describes clinical manifestations, pathophysiology, cardiac function and structure, and management of heart disease in children with CRF and post transplant. Echocardiography and Doppler ultrasonography allow differentiation of three functional disturbances: hypercirculation, systolic left ventricular (LV) dysfunction, and diastolic LV dysfunction, in addition to analysis of LV size and myocardial mass. From adult studies LV hypertrophy is recognized as an early prognostic marker of cardiovascular disease. It is present in about half of children with ESRD and after TX. It may regress, at least in part, by control of hypertension, hypervolemia, and anemia. Experimental studies have shown that, independent of these hemodynamic complications, uremia is associated with structural abnormalities of the heart, which were also described in adult patients with ESRD. These lesions consist mainly of hypertrophy of cardiomyocytes, interstitial fibrosis, and vascular changes (rarefied capillaries, thickened arteriolar walls). Cardiac complications in children with CRF and after TX deserve regular clinical and echocardiographic monitoring in order to minimize later cardiovascular morbidity by appropriate treatment.