Microalbuminuria represents a feature of advanced renal disease in patients with sickle cell haemoglobinopathy

Abstract

Chronic renal failure (CRF) occurring in sickle cell disease has a dismal outcome. The systematic screening for microalbuminuria represents the touchstone to prevent CRF in patients with diabetes mellitus. Microalbuminuria has also been demonstrated in patients with sickle cell disease. Whether this has the same prognostic significance as it does in diabetes mellitus has never been clearly stated. The purpose of the present study was to determine the prevalence of microalbuminuria and to establish the clinical significance of microalbuminuria in patients with sickle cell disease. Patients with sickle cell disease of both sexes and all ages were consecutively recruited at the haematology outpatient clinic of the Yopougon Teaching Hospital, Abidjan, Ivory Coast. in a prospective study from July to September 2004. In each patient characteristics such as age, gender, ethnic group, weight, height, blood pressure, type of haemoglobinopathy , glomerular filtration rate, complications related to the disease and current treatment were collected. Microalbuminuria was assessed in all the patients. Statistical analysis was performed to identify factors related to microalbuminuria. The prevalence of microalbuminuria was 17.3% in our study population. Glomerular filtration rate was significantly lower in the microalbuminuric group than in the normoalbuminuric group both on univariate analysis (p<0.01) and on multivariate analysis (OR=1.074) CI 95% [1.020 1.136]) (p<0.01). Height was significantly lower in the microalbuminuric group than in the normoalbuminuric group both on univariate analysis (p=0.05) and on multivariate analysis (OR=1.029 CI 95% [1.003 1.056])(p<0.05). Anaemia was more prevalent in the microalbuminuric group than in the normoalbuminuric group(p<0.05) on univariate analysis but not on multivariate analysis. No relationship has been found between microabuminuria and age, as well as with disease duration and body mass index. Microalbuminuria in sickle cell disease patients represents a feature of more advanced disease as it is significantly related to low glomerular filtration rate. The high prevalence of anaemia in the microalbuminuric patients corroborates the depressed renal function. The role of short height in the promotion of microalbuminuria is unclear.

Prevalence and Determinants of Microalbuminuria in Sickle Cell Disease Patients

“…This is due to hyperfiltration, lower muscle mass, and increased tubular secretion of creatinine in such individuals. Therefore, MA is a more reliable marker of early glomerular injury and progression to ESRD, this has been previously reported by other studies [22,23].…”