Prevalence of microalbuminuria in children with sickle cell disease

Dharnidharka, Vikas R.; Dabbagh, Shermine; Atiyeh, Bassam; Simpson, Pippa; Sarnaik, Sharada A.

doi:10.1007/s004670050491

Cited by 79 publications

(104 citation statements)

References 21 publications

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“…Therefore, it is not known whether patients with microalbuminuria will progress to macroalbuminuria. However, indirect evidence in children suggests that microalbuminuria could precede the development of macroalbuminuria in adults (14,15). In children, the development of microalbuminuria follows an age-dependent manner.…”

Section: Discussionmentioning

confidence: 99%

“…In children, the development of microalbuminuria follows an age-dependent manner. For instance, Dhranidharka et al (14) reported that microalbuminuria was not present in children who were younger than 7 yr but reached 43% in the second decade of life. In a similar study by Wigfall et al (15), the authors found an age-dependent occurrence of dipstick proteinuria: Proteinuria was not present in children who were 0 to 6 yr of age, but it occurred in 7% of children who were aged 7 to 10 yr and in 10% of children who were aged 13 to 17 yr.…”

Section: Discussionmentioning

confidence: 99%

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Glomerular Involvement in Adults with Sickle Cell Hemoglobinopathies

Guasch

Navarrete

Nass

et al. 2006

Journal of the American Society of Nephrology

227

207

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Patients with sickle cell anemia (SCA) may develop a glomerulopathy with proteinuria and progressive renal insufficiency, leading to ESRD. Albuminuria is a sensitive marker of glomerular damage in this population and precedes the development of renal insufficiency. For determination of the prevalence of glomerular damage in SCA and the clinical correlates of renal insufficiency, 300 adult patients with SCA were studied (hemoglobin SS ‫؍‬ 184; and 116 with other sickling hemoglobinopathies: SC, SD, and S-␤ thalassemia); albumin excretion rates (AER) and renal function (Cockroft-Gault formula) were determined, and clinical and hematologic evaluations were conducted. In hemoglobin SS disease, increased AER (micro-and macroalbuminuria) occurred in 68% of adult patients, and macroalbuminuria occurred in 26%. In other sickling disorders, increased AER occurs in 32% of adults, and macroalbuminuria occurs in 10%. The development of graded albuminuria was age dependent, so at 40 yr, 40% of patients with SS disease had macroalbuminuria. There were no differences in hematologic parameters (hemoglobin levels, white blood cell count, percentage of reticulocytes, platelet counts, or lactate dehydrogenase levels) between patients with normoalbuminuria and those with micro-or macroalbuminuria. By multivariate analysis, albuminuria correlated with age and serum creatinine in SS disease but not with BP or hemoglobin levels. In other sickling disorders, albuminuria tended to be associated with age but not with hemoglobin or BP levels. The diastolic BP was lower in patients with SCA than in African American control subjects, and the development of renal insufficiency, which was present in 21% of adults with SS disease, was not accompanied by significant hypertension. It is concluded that glomerular damage in adults with SCA is very common, and a majority of patients with SS disease are at risk for the development of progressive renal failure. The development of micro-and macroalbuminuria is not related to the degree of anemia, suggesting that sickle cell glomerulopathy is not solely related to hemodynamic adaptations to chronic anemia. In contrast to other glomerulopathies, the development of systemic hypertension is uncommon in SS disease with renal insufficiency.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Glomerular Involvement in Adults with Sickle Cell Hemoglobinopathies

Guasch

Navarrete

Nass

et al. 2006

Journal of the American Society of Nephrology

227

207

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“…In a cross-sectional study of 410 patients with SCD aged 2-21 (mean age 11) years, 23% had the HbSS form of SCD, with elevated urinary albumin excretion (≥30 mg/g), while other investigators have reported a HbSS prevalence of 16-27% in the childhood SCD population [18,20,21]. Further progressive kidney injury and CKD is reflected in a declining and abnormally low GFR.…”

Section: Sickle Cell Nephropathy In Childrenmentioning

confidence: 99%

Acute kidney injury in children with sickle cell disease—compounding a chronic problem

2017

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In an article recently published in Pediatric Nephrology, Baddam and colleagues discuss the relatively underreported clinical problem of repeated episodes of acute kidney injury (AKI) in children with sickle cell disease (SCD). Their report is a cautionary note about the importance of repeated kidney injury on the background of underlying chronic kidney injury and its potential implications on long-term kidney outcome. In children and adults with SCD, this includes the effects of repeated vaso-occlusive crises and the management of these painful episodes with non-steroidal anti-inflammatory drugs. Here we review the scope of kidney involvement in SCD in children and discuss the potential short-and long-term consequences of AKI in children with SCD.

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“…Thus, the early recognition of SCAN at the time of chronic kidney disease (CKD) stage I (4) and the focus on the early steps of the natural history of this nephropathy, together with the recognition of the associated clinical and biologic risk factors are of major interest. Previous works have reported the occurrence of SCAN very early in childhood, as soon as 7 years of age (5), with a prevalence of microalbuminuria of 26.5% increasing up to 40% in young adults. Macroalbuminuria is reported in 26% to 40% of patients with sickle cell anemia (SCA) depending on the age and may lead to nephrotic syndrome (1), revealing a focal glomerulosclerosis.…”

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confidence: 98%

Glomerular Hyperfiltration in Adult Sickle Cell Anemia

Haymann¹,

Stankovic²,

Lévy³

et al. 2010

Clinical Journal of the American Society of Nephrology

144

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Background and objectives: Sickle cell anemia-associated nephropathy is a growing matter of concern because renal failure affects most aging sickle cell anemia patients. Glomerular damage is a common feature revealed by a microalbuminuria or a macroalbuminuria. Although glomerular hyperfiltration has been described for decades in this population, its prevalence in young adults is unknown.Design, setting, participants, & measurements: To address this issue, as well as the clinical and biologic correlates of hyperfiltration, a single-center, cross-sectional study of 280 homozygous SS disease patients was performed.Results: The prevalence of hyperfiltration assessed by Modification of Diet in Renal Disease estimated GFR was 51%. Among patients with hyperfiltration, 49% had hyperfiltration alone, whereas 36% and 15% had an associated microalbuminuria or macroalbuminuria, respectively. Estimated GFR sensitivity and specificity for hyperfiltration were 94% and 63%, respectively, in a selected subgroup of 48 patients (measured GFR was assessed by urinary 51 Cr EDTA clearance). In patients with no albuminuria, hyperfiltration status was significantly associated with a young age (years), the absence of alpha thalassemia, a lower hemoglobin level (g/dl), and a lower fetal hemoglobin. The role of chronic hemolysis was further strengthened by multivariate analysis showing a correlation between estimated GFR and a low plasma fetal hemoglobin level, a young age, and a high reticulocyte count (r 2 ‫؍‬ 0.54). Conclusions: Together, the data suggest that the pathophysiology of hyperfiltration would rather be attributable to the hemolysis-associated vasculopathy rather than a viscosity-vaso-occlusive process.

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Prevalence of microalbuminuria in children with sickle cell disease

Cited by 79 publications

References 21 publications

Glomerular Involvement in Adults with Sickle Cell Hemoglobinopathies

Glomerular Involvement in Adults with Sickle Cell Hemoglobinopathies

Acute kidney injury in children with sickle cell disease—compounding a chronic problem

Glomerular Hyperfiltration in Adult Sickle Cell Anemia

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