Cyanotic Nephropathy-A Morphometric Analysis

Abstract

Objective Nephropathy is a known complication in cyanotic congenital heart disease (CCHD). This study was undertaken for an objective analysis of histopathological changes of cyanotic nephropathy at autopsy. Design Retrospective case records studied. Setting Tertiary care teaching hospital affiliated to medical college in Mumbai, India. Patients and Methods The renal histopathological findings of 50 consecutive autopsies in patients with CCHD were compared with 25 age-matched controls. The Bowman's capsular, glomerular tuft, and hilar arteriolar diameters were measured morphometrically. Statistical analysis was performed using unpaired t-test. A P value equal to or less than .05 was considered significant. Results Among the 50 autopsied cases of CCHD, there were 35 males and 15 females, with a mean age of 4.64 years. The renal changes observed were glomerulomegaly, glomerulosclerosis, periglomerular fibrosis, hyperplastic arteriolosclerosis, and interstitial fibrosis. The objectively measured parameters were higher in cases as compared with controls in all age groups, and further these were also found to be higher in patients having decreased pulmonary arterial blood flow than those having normal to increased pulmonary arterial blood flow. The difference in Bowman's capsular and glomerular tuft diameters was statistically significant in the neonates and children in the age groups, 1–5 years and above 10 years. The difference in hilar arteriolar diameter was statistically significant for all age groups except neonates. Conclusion Patients with CCHD show significant changes in the kidneys as assessed morphometrically, leading to renal dysfunction, and the age of the patients plays a role in their development.