Masked hypertension is prevalent in children with sickle cell disease: a Midwest Pediatric Nephrology Consortium study

Shatat, Ibrahim F.; Jakson, Sherron M.; Blue, Amanda E.; Johnson, Mary Ann; Orak, John K.; Kalpatthi, Ram

doi:10.1007/s00467-012-2275-9

Cited by 45 publications

(51 citation statements)

References 28 publications

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“…Our cohort confirms prior pediatric studies that demonstrate a lack of correlation between hypertension defined by in-clinic BP monitoring and 24 hour ABPM [21, 35]. In addition, our cohort mirrors the results of two prior studies which suggested that SCA patients have a higher prevalence of nocturnal hypertension and lack of nocturnal dipping in pediatric SCA [21, 22]. The prevalence of non-dipping in this SCA study (70 % abnormal SBP dipping and 50 % abnormal DBP dipping) is higher than obese pediatric patients (42 % and 17 % abnormal SBP and DBP dipping) or patients with diabetes (20-40 % abnormal dipping) [36-38].…”

Section: Discussionsupporting

confidence: 88%

“…Ambulatory blood pressure monitoring (ABPM), which identifies nocturnal hypertension, is superior to casual in-clinic blood pressure monitoring for identifying children at high risk for end-organ damage [20]. Two prior studies have identified a high prevalence of nocturnal hypertension in SCA, yet no data are available to define the association between nocturnal hypertension and eGFR in SCA [21, 22]. Hyperuricemia has been associated with hypertension and cardiovascular events in other diseases but, despite the high prevalence of hyperuricemia in SCA, the association of hyperuricemia and sickle cell nephropathy has not been explored [18, 19].…”

Section: Introductionmentioning

confidence: 99%

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Evaluating risk factors for chronic kidney disease in pediatric patients with sickle cell anemia

et al. 2017

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Background Patients with Sickle Cell Anemia (SCA) have an increased prevalence of nephropathy and mortality from chronic kidney disease (CKD). Methods We evaluated the association of hyperuricemia and nocturnal hypertension with lower estimated glomerular filtration rate (eGFR) by cystatin-C among patients 10-21 years old with HbSS or SB0 thalassemia during a non-acute clinic visit. eGFR was obtained in 83 participants, uric acid in 81, and 24 hour ambulatory blood pressure monitoring (ABPM) was performed in 44 participants. Vital signs, CBC, CMP, LDH, medications, and urine microalbumin/creatinine were measured. Hyperuricemia was defined as a uric acid level ≥5.5 mg/dL. Nocturnal hypertension was defined as >25 % of nocturnal readings >95th percentile according to norms established by the American Heart Association Statement on ABPM in children and adolescents. Results The mean eGFR was statistically significantly lower among patients with hyperuricemia than with normal uric acid levels (143 vs 161 mL/min/1.73m2, respectively). Fourteen of 44 (32 %) participants had systolic nocturnal hypertension and 12 of 44 (27 %) had diastolic nocturnal hypertension. The mean eGFR was statistically significantly lower among participants with nocturnal systolic and diastolic hypertension than normal nocturnal blood pressure. In a regression model, nocturnal hypertension and hyperuricemia were associated with a lower eGFR. Conclusion Two risk factors for CKD, nocturnal hypertension and hyperuricemia, were associated with lower eGFR in older children and adolescent patients with SCA, and warrant long-term studies of their association with progression to CKD in this population.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Evaluating risk factors for chronic kidney disease in pediatric patients with sickle cell anemia

et al. 2017

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“…There is little data about hypertension in children suffering from SCD. In a recent study, high frequency of abnormalities in BP measurements was reported [12]. However, hypertension in SCD is difficult to classify and normal values in sickle cell patient require more attention.…”

Section: Discussionmentioning

confidence: 97%

Renal Function in Children Suffering from Sickle Cell Disease: Challenge of Early Detection in Highly Resource-Scarce Settings

et al. 2014

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BackgroundThe prevalence of Sickle cell disease is extremely high in Democratic Republic of Congo. Despite this high prevalence of the disease, data on renal abnormalities in children are rare.MethodThe study proposed to assess blood pressure, glomerular function, urea and uric acid levels in 65 steady state Congolese children with homozygous sickle cell disease and 67 normal controls.ResultsIn Hb-SS group, blood pressure level tended to be lower than Hb-AA groups but there was no statistically significant difference (p>0.05) between the two groups. The absolute values for GFR corrected for BSA were significantly higher in Hb-SS group compared to Hb-AA group (130.5±34.1 ml/min/1.73 m2 vs 113.7±24.5 ml/min/1.73 m2; p = 0.004). Children with Hb-SS were more likely to hyperfiltrate (30.8% of subjects) than children with Hb-AA (6.1% of subjects). Proteinuria was found in 4 (6.2%) children with Hb-SS. Uric acid level was significantly increased in children with Hb-SS compared to corresponding values in control group (4.4±1.3 mg/dl vs 3.5±1.1 mg/dl; p<0.001). Urea level was significantly decreased compared to corresponding values in Hb-AA group (15.3±8.3 mg/dl vs 22.9±10.1 mg/dl; p<0.001).ConclusionHyperfiltration, low creatinine, lower urea and high uric acid are more common in children with sickle cell disease than in normal controls.

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“…However, masked hypertension is common in pediatric SCD and could contribute to SCN pathophysiology [32,33]. These processes are summarized in Figure 1.…”

Section: Pathophysiologymentioning

confidence: 99%

Sickle Cell Nephropathy in the Pediatric Population

et al. 2018

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Background: Compared to the past, patients with sickle cell disease (SCD) currently live longer due to improvements in diagnosis and comprehensive care. Due to these advances, long-term chronic complications pose a greater challenge in the management of patients with SCD. In particular, sickle cell nephropathy (SCN) is associated with significant morbidity and mortality across all age groups. Furthermore, SCN is an understudied condition with relatively few symptoms and therefore requires close surveillance. In this review, we sought to explore the epidemiology, natural history, and treatment options for SCN with an emphasis on the pediatric population. Summary: SCN invariably begins in childhood with evidence of structural changes detected as early as infancy. These indolent changes can progress undetected to advanced chronic kidney disease by late adolescence or early adulthood. The risk factors for progression are not well defined, but significant albuminuria (which is also the most common presentation in childhood) is a key factor in progression. One of the main challenges in understanding SCN in children is the poor correlation between estimated and measured glomerular filtration rates. Another challenge is the lack of large-scale longitudinal studies that track the clinical outcomes of pediatric patients over time. Several studies aim to identify early biomarkers of SCN in children, as albuminuria presents only following significant chronic damage. The utility of angiotensin converting enzyme inhibitors and hydroxyurea in treating albuminuria is addressed here as well as novel treatments that may be of benefit.

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Masked hypertension is prevalent in children with sickle cell disease: a Midwest Pediatric Nephrology Consortium study

Abstract: Abnormalities in ABP measurements and patterns in children with SCD are prevalent and require more attention from heath care providers. ABPM is a valuable tool in identifying masked hypertension and abnormalities in circadian BP.

Cited by 45 publications

References 28 publications

Evaluating risk factors for chronic kidney disease in pediatric patients with sickle cell anemia

Evaluating risk factors for chronic kidney disease in pediatric patients with sickle cell anemia

Renal Function in Children Suffering from Sickle Cell Disease: Challenge of Early Detection in Highly Resource-Scarce Settings

Sickle Cell Nephropathy in the Pediatric Population

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