日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

Renal dysfunction, severe heart failure, anemia, administration of diuretics, and dehydration are risk factors for contrast-induced nephropathy (CIN). The renal dysfunction is reversible in most cases of CIN, and renal replacement therapy is rarely required. Cyanotic nephropathy (CN) and relative anemia often occur in patients with cyanotic congenital heart diseases (CCHD). Although diuretic administration and fluid restriction for refractory heart failure are recommended, the association between the use of contrast media for patients with CCHD and the risk of developing CIN remains unclear. We report the case of a 30-year-old woman who had undergone a Blalock–Taussig shunt procedure at 3 months of age after being diagnosed with pulmonary atresia with intact ventricular septum, and at 15 years of age presented with proteinuria and was diagnosed with CN based on renal biopsy. During hospitalization for management of exacerbated chronic heart failure, we performed cardiac catheterization for hemodynamic evaluation. After catheterization, she developed oliguria, pleural effusion, ascites, and prolonged metabolic acidosis. Her serum creatinine levels increased from 0.79 mg/dL to 3.86 mg/dL. Based on these findings, we diagnosed the patient with CIN and performed continuous hemodiafiltration for 8 days. Patients with CCHD may be at a high risk of developing CIN and the severity may be higher in cases with CN. In these circumstances, it is necessary to carefully consider the indication and amount of contrast agent required.