Urinary Hepcidin in Diagnosis of Iron Deficiency Anemia

Abstract

Iron Deficiency Anemia (IDA) is a common health problem among children especially in developing countries. Traditionally, symptoms such as pallor, as well as evidence collected from l complete blood pictures (CBC) and a serum ferritin tests have been among standard clinician and laboratory methods of diagnosing IDA. More recently, advanced research has focused on the use of hepcidin as a main regulator of iron absorption and metabolism as a measure of degree of anemia. Hepcidin has been detected in both serum and urine. We aimed in this study to evaluate the use of urinary hepcidin in the form of a hepcidin creatinized ratio in diagnosis of IDA. In this case, control study, 45 IDA children aged 6-10 years and another 45 healthy non-anemic children aged 6-10 years were recruited. Laboratory tests, including CBCs, serum ferritin and urinary hepcidin levels (by ELISA) were conduct. Significantly lower hemoglobin levels, MCV, MCH, ferritin, serum iron, hepcidin and Hepcidin creatinine ratios were detected in cases of anemia compared to controls. The only exceptions were RDW percentages that were significantly higher in cases compared to controls. In our study, urinary levels of hepcidin (ng mgG 1 creat) showed a significantly positive correlation with HB, MCV, MCH and serum iron and ferritin levels. On the other hand, urinary hepcidin level showed a significantly negative correlation with RDW percentages. A Receiver Operating Characteristics (ROC) curve was used to detect the cutoff for urinary hepcidin levels. This cut off was to be used to differentiate IDA patients, from healthy children. The cutoff point differentiating IDA from healthy children was concluded to be at 1.3 ng mgG 1 creat. The area under the ROC curve was 0.7; sensitivity was 91% and specificity of the cutoff point was 51%. We find that urinary hepcidin correlated positively with serum ferritin levels in children and that it was significantly lower in children with IDA. Urinary hepcidin thus seems to be a simple, non-invasive and sensitive parameter for the estimation of serum iron and iron stores.