Renal memory in the Glenn-Fontan acute kidney injury continuum: A window for early renal protection

IF 0.4 Q4 PEDIATRICS

PROGRESS IN PEDIATRIC CARDIOLOGY Pub Date : 2026-03-01 Epub Date: 2026-02-05 DOI:10.1016/j.ppedcard.2026.101910

Eitan Keizman , Asaf Mandel , Yshia Langer , Salmas Watad , Hiba Abuelhija , Alexander Lowenthal , Reut Kassif Lerner , David Mishaly , Alain E. Serraf , Uri Pollak

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引用次数: 0

Abstract

Background

Acute kidney injury (AKI) is a common and serious complication following Fontan completion in children with single ventricle physiology. While risk factors for post-Fontan AKI are well studied, it remains unknown whether prior AKI after the Glenn procedure can predict subsequent renal injury.

Objectives

To determine whether AKI after the Glenn procedure is associated with AKI after Fontan completion, and to characterize the persistence of AKI severity across staged palliation.

Methods

This retrospective cohort study included 98 pediatric patients who underwent Fontan surgery between 2009 and 2016. AKI after both Glenn and Fontan procedures was assessed using KDIGO and pRIFLE classification systems. Statistical analyses included odds ratios, cross-tabulations, and correlation tests to evaluate the relationship between post-Glenn and post-Fontan AKI.

Results

Among patients who developed AKI after Glenn, 87.5% (KDIGO) and 80% (pRIFLE) experienced AKI again after Fontan. Patients with Glenn-related AKI were over 14 times more likely to develop post-Fontan AKI (OR = 14.36, p = 0.001). Notably, 100% of patients with severe (“failure” category) Glenn AKI developed Fontan AKI, and 75% remained in the severe category. Despite weak correlation coefficients, categorical analysis highlighted a clinically significant predictive relationship. Only 2% required ECMO post-Fontan, and overall mortality was 5.1%.

Conclusions

AKI following the Glenn procedure is a strong predictor of subsequent AKI after Fontan completion. This finding suggests a possible continuum of renal vulnerability across staged palliation, supporting the concept of “renal memory.” Integrating prior renal response into pre-Fontan risk assessment could enable early intervention and tailored perioperative strategies.

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Glenn-Fontan急性肾损伤连续体中的肾记忆：早期肾保护的窗口

背景：急性肾损伤（AKI）是单心室生理的儿童Fontan完成治疗后常见且严重的并发症。虽然fontan手术后AKI的危险因素已经得到了很好的研究，但Glenn手术后的AKI是否可以预测随后的肾损伤仍是未知的。目的确定Glenn手术后的AKI是否与Fontan完成后的AKI相关，并表征AKI严重程度在分期缓解期间的持久性。方法回顾性队列研究纳入2009 - 2016年间行Fontan手术的98例患儿。使用KDIGO和prile分类系统对Glenn和Fontan手术后的AKI进行评估。统计分析包括比值比、交叉表和相关检验，以评估glenn和fontan后AKI之间的关系。结果Glenn术后发生AKI的患者中，87.5% （KDIGO）和80% （prile）在Fontan术后再次发生AKI。glenn相关性AKI患者发生fontan后AKI的可能性是其14倍以上（OR = 14.36, p = 0.001）。值得注意的是，100%的严重（“失败”类别）Glenn AKI患者发展为Fontan AKI， 75%仍然是严重类别。尽管相关系数较弱，但分类分析强调了临床显著的预测关系。只有2%的患者在fontan后需要ECMO，总死亡率为5.1%。结论Glenn手术后AKI是Fontan手术后AKI的重要预测指标。这一发现表明，在分期缓解过程中，肾脏易损性可能是连续的，支持“肾脏记忆”的概念。将先前的肾脏反应纳入fontan前风险评估可以实现早期干预和量身定制的围手术期策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

PROGRESS IN PEDIATRIC CARDIOLOGY PEDIATRICS-

CiteScore

0.90

自引率

11.10%

发文量

审稿时长

75 days

期刊介绍： Progress in Pediatric Cardiology is an international journal of review presenting information and experienced opinion of importance in the understanding and management of cardiovascular diseases in children. Each issue is prepared by one or more Guest Editors and reviews a single subject, allowing for comprehensive presentations of complex, multifaceted or rapidly changing topics of clinical and investigative interest.