Our Summary

This research paper looks at how certain genes might affect the risk of kidney injury in children after heart surgery. Kidney injury happens in 30-50% of children following heart surgery. The researchers studied over 2,000 patients who had heart surgery at a children’s hospital between 2007 and 2020. They focused on specific genes that could influence kidney blood flow and inflammation, which have previously been linked to kidney injury in adults after heart surgery. They found that one specific variant of a gene called NOS3 was associated with a lower risk of kidney injury after surgery. This remained true even after accounting for other factors like body size, genetic syndromes, surgery risk scores, time on heart-lung machine, and exposure to kidney-damaging medication. The researchers suggest that understanding these genetic factors could help identify which children are at higher risk of kidney injury after heart surgery.

FAQs

  1. What is the prevalence of kidney injury in children following heart surgery?
  2. Which specific gene was found to be associated with a lower risk of kidney injury after heart surgery in children?
  3. How might understanding these genetic factors help identify children at higher risk of kidney injury following heart surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about pediatric cardiac surgery is to discuss any family history of kidney issues or genetic conditions that may increase the risk of kidney injury following surgery. By understanding these genetic factors, doctors can better tailor the treatment plan to reduce the risk of kidney injury and improve outcomes for the child. It is important for parents to communicate any relevant medical history with their child’s healthcare team to ensure the best possible care.

Suitable For

Patients who are typically recommended pediatric cardiac surgery include those with congenital heart defects, heart rhythm abnormalities, and acquired heart diseases. These patients may be infants, children, or adolescents who are experiencing symptoms such as difficulty breathing, poor growth, fatigue, or cyanosis (bluish tint to the skin). Pediatric cardiac surgery may be recommended to repair structural abnormalities in the heart, correct heart rhythm disorders, or improve heart function. In some cases, surgery may be necessary to prevent complications such as heart failure, stroke, or sudden cardiac arrest.

Timeline

Before pediatric cardiac surgery:

  • Patient undergoes pre-operative testing and evaluations to assess their overall health and determine the best course of treatment
  • Patient and their family meet with the surgical team to discuss the procedure, risks, and potential outcomes
  • Patient may undergo imaging tests, blood work, and other diagnostic tests to ensure they are ready for surgery

After pediatric cardiac surgery:

  • Patient is closely monitored in the intensive care unit (ICU) immediately following surgery
  • Patient may require mechanical ventilation and medications to support heart function and prevent infection
  • Patient will gradually be weaned off of medications and monitoring as their condition stabilizes
  • Patient will undergo physical therapy and rehabilitation to regain strength and function
  • Patient will have follow-up appointments with their surgical team to monitor their progress and address any concerns or complications

What to Ask Your Doctor

  1. What is the likelihood of my child experiencing kidney injury following heart surgery?
  2. Are there any specific genetic factors that could increase my child’s risk of kidney injury?
  3. How can genetic testing help in identifying children at higher risk of kidney injury after heart surgery?
  4. Are there any preventive measures or treatments that can be tailored based on genetic factors to reduce the risk of kidney injury in my child?
  5. What are the potential long-term implications of kidney injury in children after heart surgery?
  6. Are there any lifestyle changes or medications that can help protect my child’s kidneys post-surgery, especially considering their genetic predisposition?
  7. How often will my child need to be monitored for kidney function following heart surgery, and what tests will be performed?
  8. Are there any support resources or specialists available to help manage kidney health in children who have undergone cardiac surgery?

Reference

Authors: Kikano S, Breeyear J, Aka I, Edwards TL, Van Driest SL, Kannankeril PJ. Journal: Am Heart J. 2022 Dec;254:57-65. doi: 10.1016/j.ahj.2022.08.003. Epub 2022 Aug 19. PMID: 35988586