Renal involvement and its detection in sickle cell disease children
DOI:
https://doi.org/10.18203/2349-3291.ijcp20150524Keywords:
Sickle cell anemia, Kidney functions, Microalbuminuria, Renal DopplerAbstract
Background: Sickle cell disease is common in this part of India. Study tries to find extent of renal involvement, risk factors and screening tests in sickle cell disease.
Methods: Convenient Prospective, cross sectional, observational study among known sickle cell anemia (homo and heterozygous) children and Fifty controls. Demographic and clinical findings were recorded. Renal function tests including serum sodium and potassium, eGFR were studied. Presence of microalbuminuria was checked and renal Doppler study was performed.
Results: Total 110 homozygous (SS type), 55 heterozygous (AS type) and 50 normal children were recruited. Majority belonged to low socioeconomic state with male preponderance. More patients in crisis had high Urea (23%) and Creatinine (43%) than in steady state (high urea 3.38%, high creatinine 15%). In AS type children also high urea (3.6%) and creatinine (11%) was found. A subgroup in SS and AS type had lower than normal urea and creatinine. Sodium and potassium abnormality also was found in both groups. eGFR was high below 5 years and then came down. All parameters worsened with age. Renal Doppler was better indicator of renal damage than microalbuminuria.
Conclusions: Renal involvement is common in sickle cell anemia. Increasing age, male sex and homozygous state were risk factors. Renal Doppler and micro-albuminuria are good screening tests. Renal Doppler was marginally superior.
References
Lanzkowsky P. Hemoglobinopathies, sickle cell disease. In: Lanzkowsky P, eds. Manual of Pediatric Hematology. 5th ed. US: Elsevier; 2011: 201-224.
Kamble M, Chatruvedi P. Epidemiology of sickle cell disease in a rural hospital of Central India. Indian Pediatr. 2000;37:391-6.
Marsenic O, Couloures KG, Wiley JM. Proteinuria in children with sickle cell disease. Nephrol Dial Transplant. 2008 Feb;23(2):715-20.
Abbate M, Zoja C, Remuzzi G. How proteinuria does cause progressive renal damage? J Am Soc Nephrol. 2006;17:2974-84.
Alvarez O, Lopez-MG, Zilleruelo G. Short term follow-up of patients with sickle cell disease and albuminuria. Pediatr Blood Cancer. 2008 Jun;50(6):1236-9.
Guasch A, Navarrete J, Nass K, Zayas CF. Glomerular involvement in adults with sickle cell hemoglobinopathies: prevalence and clinical correlates of progressive renal failure. J Am Soc Nephrol. 2006 Aug;17(8):2228-35.
Vikram D, Janaki R, Ayengar SK, Chaturvedi P. Microalbuminuria as a predictor of early glomerular injury in children with sickle cell disease. Indian J Pediatr. 2003;70(4):307-9.
Schwartz GJ, Haycock GB, Edelmann CM, Spitzer A. A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics. 1976;58:259-63.
Aloni MN, Ngiyulu RM, Gini-Ehungu J-L, Nsibu CN, Ekila MB, Lepira FB, et al. Renal function in children suffering from sickle cell disease: challenge of early detection in highly resource-scarce settings. PLoS One. 2014;9(5):e96561.
Australian Institute of Health and Welfare. Person-microalbumin level (measured), total micrograms per minute N[NNN].N. In: AIHW, eds. National Health Data Dictionary. Version 16. Australia: Australian Institute of Health and Welfare; 2012.
Bude RO, Rubin JM. Relationship between the resistive index and vascular compliance and resistance. Radiology. 1999;211(2):411-7.
Kamble M, Chatruvedi P. Epidemiology of sickle cell disease in a rural hospital of Central India. Indian Pediatr. 2000;37:391-6.
Jain D, Mehrotra A. Clinical profile of sickle cell trait in tertiary care hospital in central India. J DMER. 2003 Jul;2(3):149-53.
Gladwin MT, Schechter AN, Ognibene FP, Coles WA, Reiter CD, Schenke WH, et al. Divergent nitric oxide bioavailability in men and women with sickle cell disease. Circulation. 2003;107:271-8.
Patel AB, Athavale AM. Sickle cell disease in central India. Indian J Pediatr. 2004 Sep;71(9):789-93.
MSadat-Ali, Al Habden. Has improvement in economic status changed the pattern and severity of bone and joint complications in sickle cell disease? Indian J Orthop. 2003;37(3):47-9.
Ter Maarten JC, Gans RO, de Jong PE. Sickle cell disease. In: Feehally R, Johnson RJ, Comprehensive Clinical Nephrology. 3rd ed. US: Mosby; 2007: 573.
Hsien HC, Joao Thomas A, Josephina C, Aparecida PB. Blood pressure in children with sickle cell disease. Rev Paul Pediatr. 2012;30(1):87-92.
Rajiv Y, Gupta RB, Bharadwaj VK, et al. Morbidity Profile of Sickle Cell Disease in Central India. Proceeding Natl Sympos Tribal Health. 1999;1:136-40.
Sanjay M, Khurana VL, Sonesh JK. Sickle cell anemia in Garasia Tribals of Rajasthan. Indian Pediatr. 2009;46:239-40.
Christopher BE, Henrietta UO, Bede CI. Prevalence and correlates of microalbuminuria in children with sickle cell anaemia: experience in a tertiary health facility in Enugu, Nigeria. Int J Nephrol. 2012;2012:240173.
Edgar VL. Sickle cell nephropathy, 2014. Available at: emedicine.medscape.com/article/247004.
Al-Naama LM, Al-Sadoon EA, Al-Sadoon TA. Levels of uric acid, urea and creatinine in Iraqi children with sickle cell disease. J Pak Med Assoc. 2000 Mar;50(3):98-102.
Aloni MN, Ngiyulu RM, Gini-Ehungu JL, Nsibu CN, Ekila MB, Lepira FB, et al. Renal function in children suffering from sickle cell disease: challenge of early detection in highly resource-scarce settings. PLoS One. 2014 May;9(5):e96561.
Paula RP, Nascimento AF, Sousa, SM, Bastos PR, Barbosa AA. Glomerular filtration rate is altered in children with sickle cell disease: a comparison between Hb SS and Hb SC. Rev Bras Hematol Hemoter. 2013;35(5):349-51.
Ataga KI, Orringer EP. Renal abnormalities in sickle cell disease. Am J Hematol. 2000;63(4):205-11. Comment in: Am J Hematol. 2001;66(1):68-9.
Guasch A, Navarrete J, Nass K, Zayas CF. Glomerular involvement in adults with sickle cell hemoglobinopathies: prevalence and clinical correlates of progressive renal failure. J Am Soc Nephrol. 2006;17(8):2228-35.
Anigilage EA, Adeniyi A, Adedoyin OT. Effect of sickle cell crises on glomerular filtration rate in children with sickle cell disease in Iiorin, Nigeria. Indian J Nephrol. 2013 Sept-Oct;23(5):354-7.
Aderibigbe A, Arije A, Akinkugbe OO. Glomerular function in sickle cell disease patients during crisis. Afr J Med Sci. 1994;23:153-60.
Agoreyo FO, Nwanze N. Plasma sodium and potassium changes in sickle cell patients. Int J Genet Molecul Biol. 2010;2(2):014-9.
Miller ST, Wang WC, Iyer R, Rana S, Lane P, Ware RE, et al. Urine concentrating ability in infants with sickle cell disease: baseline data from the phase III trial of hydroxyurea (BABY HUG). Pediatr Blood Cancer. 2010 Feb;54(2):265-8.
Taori KB, Chaudhary RS, Attarde V, Dhakate S, Sheorain V, Nimbalkar P, et al. Renal Doppler indices in sickle cell disease: early radiologic predictors of renovascular changes. AJR Am J Roentgenol. 2008;191:239-42.
Mohanty J, Narayan JVS, Bhagat S, Panda BB, Satpathi G, Saha N. Sonological evaluation of abdominal organs in sickle cell crisis in Western Orissa. Indian J Radiol Imaging. 2004;14(3):247-51.