Feygina V1*, Rey K2, Hatano M2, Paudyal B1, Mongia AK1, Schoeneman MJ1, Bansilal V1, Miller ST2 and Tawadrous H1
1Division of Pediatric Nephrology, SUNY Downstate Medical Center, NY 11203, USA
2Division of Pediatric Hematology and Oncology, SUNY Downstate Medical Center, NY 11203, USA
Renal complications are common in children with sickle cell anemia (HbSS). No treatment is proven to slow progression of sickle cell nephropathy (SCN). Both hydroxyurea (HU) and chronic blood transfusion (BT) reduce common complications of sickle cell disease; little has been reported regarding the effect of these treatments on renal function.
We did an extensive assessment of renal function (estimated glomerular filtration rate (eGFR), renal osmolality, renal protein, fractional excretion of sodium (FeNa), trans-tubular potassium gradient (TTKG), and phosphorus re-absorption) on children (age 7 years-21 years) receiving these treatments for other sickle cell complications. Nine patients on BT (duration 26.7 ± 10.7 mo) and 17 on HU (56.1 ± 45.9 mo) with HbSS were enrolled. There was a high prevalence of hyper-filtration (mean eGFR of 150.2 ± 31.7 ml/min/1.72 m2 and 172.0 ± 31.7 ml/min/1.72 m2 in HU and BT groups, respectively), with a trend (p-0.06) toward less hyper-filtration in the HU group. Overall, 18.75% and 20.8% of patients from both groups have microalbuminuria and proteinuria respectively. Our data confirm a high prevalence of sickle cell nephropathy despite these disease modifying treatments. Further larger, longitudinal studies, importantly including untreated controls if possible, are necessary to clarify the impact, if any, of HU or BT on sickle cell nephropathy.
Sickle cell nephropathy; hyper-filtration; Proteinuria; Microalbuminuria
Feygina V, Rey K, Hatano M, Paudyal B, Mongia AK, Schoeneman MJ, et al. Effects of Hydroxyurea or Chronic Blood Transfusion on Renal Function in Children with Sickle Cell Disease. J Clin Nephrol Kidney Dis. 2017; 2(1): 1008.