scholarly journals Sickle Cell Nephropathy and Associated Factors among Asymptomatic Children with Sickle Cell Anaemia

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Uchenna Modestus Nnaji ◽  
Christian Chukwukere Ogoke ◽  
Henrietta Uche Okafor ◽  
Kingsley I. Achigbu
Keyword(s):  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Steady State ◽  
Glomerular Filtration ◽  
Sickle Cell ◽  
Filtration Rate ◽  
Sickle Cell Anaemia ◽  
Asymptomatic Children ◽  
Increased Risk ◽  
Sickle Cell Nephropathy

Background. Sickle cell nephropathy (SCN) is a serious complication of sickle cell anaemia (SCA) with asymptomatic onset in childhood and possible progression to chronic kidney disease (CKD). In Southeast Nigeria, few studies have evaluated renal function in paediatric SCA patients for early detection of renal impairment and early intervention to reduce morbidity and mortality. Therefore, this study evaluated the renal function of paediatric SCA patients in a steady state based on glomerular filtration rate and urinalysis findings (proteinuria and haematuria). Methods. A cross-sectional study of consecutively recruited sixty haemoglobin SS (HbSS) children in a steady state and sixty age- and sex-matched haemoglobin AA (HbAA) controls aged 2–18 years was done. Renal function of HbSS subjects was evaluated using estimated glomerular filtration rate (eGFR) which was compared with healthy HbAA subjects. The prevalence of significant proteinuria and haematuria, its association with eGFR, and the effect of past sickle cell crisis (in the preceding 24 months) on renal function were also evaluated. Results. Mean eGFR was significantly higher in HbSS subjects than in the HbAA subjects (p=0.001) and decreased with age. Significant proteinuria and haematuria were more prevalent in the HbSS group (3.4% and 6.7%, respectively) compared to the HbAA subjects (0% and 0%, respectively) (p=0.496 and 0.119, respectively). No significant association was observed between eGFR and proteinuria (p=1.000) or haematuria (p=1.000). There was a positive correlation between eGFR and frequency of past painful crisis that required hospitalization (r=0.138, p=0.295) and between eGFR and frequency of blood transfusion (r=0.679, p≤0.001). Conclusions. Asymptomatic paediatric HbSS (SCA) patients had higher mean eGFR indicating an increased risk of nephropathy. There was no association between eGFR and proteinuria or haematuria. Frequent sickle cell crises especially one requiring transfusion were positively correlated with hyperfiltration.

scholarly journals Microalbuminuria risks and glomerular filtration in children with sickle cell anaemia in Nigeria

2019 ◽  
Vol 45 (1) ◽  
Author(s):  
I. E. Ocheke ◽  
S. Mohamed ◽  
E. S. Okpe ◽  
F. Bode-Thomas ◽  
M. I. McCullouch
Keyword(s):  
Risk Factors ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Sickle Cell ◽  
Filtration Rate ◽  
Sickle Cell Anaemia ◽  
Estimated Glomerular Filtration Rate ◽  
Kidney Damage ◽  
Strong Positive Correlation ◽  
Cross Sectional

Abstract Introduction Evidence of kidney damage is observed in children with sickle cell anaemia (SCA) and this continues through adulthood with progression to severe functional impairment in some. One of the earliest features of kidney damage associated with SCA is microalbuminuria. Our objective was to determine the risk factors of microalbuminuria in these children and its relationship with estimated glomerular filtration rate. Methods This was a cross-sectional and comparative study involving three hundred and twenty three children with SCA in steady state and equal numbers of apparently healthy age and sex matched haemoglobin AA (HbAA) control, aged 6 months to 18 years. They were consecutively recruited over a 6 month period. Result Microalbuminuria was present in 26% of the study subjects compared with 1.85% of control P = 0.001). Anaemia and high estimated glomerular filtration rate (eGFR) showed strong positive correlation with microalbuminuria (OR = 3.19, CI 0.953–1.116, p = 0.003 and OR = 1.7, CI 1.042–1.066, p = 0.001 respectively). Similarly, eGFR was higher in subjects with SCA than in controls and as well as in those with microalbuminuria compared with those who do not (p = < 0.01). Conclusions The two most important risk factors for microalbuminuria were anaemia and high eGFR. Age category was associated more with microalbuminuria than just age as a variable. Glomerular filtration rate was higher in children with microalbuminuria than those who do not and it was also higher in children with SCA than in control.

Elevated Glomerular Filtration Rate (GFR) in Young Patients with Sickle Cell Anemia.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3745-3745
Author(s):  
Sherri A. Zimmerman ◽  
Jacqueline S. Davis ◽  
Nicole A. Mortier ◽  
Russell E. Ware
Keyword(s):  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Young Children ◽  
Glomerular Filtration ◽  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Filtration Rate ◽  
Plasma Clearance ◽  
Glomerular Hyperfiltration ◽  
Schwartz Equation

Abstract Nephropathy is a well-recognized complication of sickle cell anemia (SCA) that is associated with considerable morbidity and mortality. Sickle nephropathy begins early in life, with glomerular damage characterized by hyperfiltration and glomerulomegaly, as well as tubular damage characterized by hyposthenuria. School-aged children can develop proteinuria and one-third of patients will eventually develop chronic renal failure as adults. Among the earliest markers of sickle nephropathy is glomerular hyperfiltration, typically measured as an elevated glomerular filtration rate (GFR). To date, however, no formal measurements of GFR have been published in young children with SCA, and its feasibility and interpretation in this age group have not been demonstrated. As part of a prospective, single-institution, IRB-approved open-label protocol using hydroxyurea in toddlers with SCA, the pre-treatment GFR was measured using plasma clearance of 99-Tc DTPA. The goal of this procedure was to determine the onset of hyperfiltration among young children with SCA, to identify risk factors associated with its onset, and to investigate the potential benefit of hydroxyurea in improving or preserving renal function. After intravenous injection of the DTPA radiotracer, 3–5 mL aliquots of venous blood were removed at 1 and 3 hours post-injection and analyzed for plasma radioactivity. Because DTPA is filtered at the glomerulus without substantial metabolism, secretion, or reabsorption, the plasma clearance allows an accurate and precise GFR measurement. The GFR was also estimated using the Schwartz equation, where GFR = height (cm) x k/serum creatinine, with k=0.55 for children between ages 1 and 12 years. A total of 13 children with HbSS (3 females, 10 males) were enrolled in this study, none of whom had laboratory evidence of renal disease at the time of evaluation. One child could not complete the DTPA study due to inadequate venous access. For the remaining 12 children, baseline GFR measurements were performed at age 3.0 ± 0.8 years (range 1.7 to 4.4 years) without complications. The average GFR measurement (mean ± SD) by DTPA clearance was 140.3 ± 20 mL/min/1.73m2, median 133 mL/min/1.73m2, range 117.9 to 172.7 mL/min/1.73m2 (normal 100 ± 20 mL/min/1.73m2). The baseline DTPA GFR measurement was elevated above 150 mL/min/1.73m2 in 5 of the 12 children, including 4 of 7 over age 3 years, although there was no signfiicant correlation between GFR and age or fetal hemoglobin. GFR estimates by the Schwartz equation were modestly correlated with the DTPA GFR measurements (R2 = 0.32, p = 0.055) but were typically slightly higher than the corresponding DTPA measurements. Three children who completed 24 months of hydroxyurea therapy had post-treatment DTPA clearance studies that revealed stable GFR measurements (average increase = 5.6 mL/min/1.73m2). These results illustrate that GFR measurement by DTPA clearance can be performed without difficulty in young children with SCA, requiring only peripheral intravenous access. Glomerular hyperfiltration as a manifestation of renal damage begins early in life for children with SCA, with elevated GFR values observed in the toddler age range. The Schwartz equation provides an estimate of GFR but probably cannot be used in lieu of the DTPA clearance study. Treatment with hydroxyurea may preserve renal function by abrogating further GFR hyperfiltration.

scholarly journals Association of the Reproductive Period with Decreased Estimated Glomerular Filtration Rate in Menopausal Women: A Study from the Shanghai Suburban Adult Cohort and Biobank (2016–2020)

2021 ◽  
Vol 18 (19) ◽  
pp. 10451
Author(s):  
Yuting Yu ◽  
Qi Zhao ◽  
Yonggen Jiang ◽  
Na Wang ◽  
Xing Liu ◽  
...  
Keyword(s):  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Lower Risk ◽  
Filtration Rate ◽  
Estimated Glomerular Filtration Rate ◽  
Reproductive Period ◽  
Increased Risk ◽  
Menopausal Women ◽  
Metabolic Equivalent Of Task

In previous studies, it has been documented that a short reproductive period is associated with a higher risk of diabetes, cardiovascular disease, and chronic kidney disease. This study aims to investigate the association of the reproductive period length with decreased renal function. This study obtained data from “the Shanghai Suburban Adult Cohort and Biobank”. An estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m2 indicated decreased renal function during follow-up. Participants were grouped into quintiles by reproductive period. Logistic regression analysis was performed to examine the association between the reproductive period and decreased renal function. A total of 5503 menopausal women with baseline eGFR > 60 mL/min/1.73 m2 were included. Age, eGFR, and metabolic equivalent of task (MET) at baseline were 61.0 (range, 36.0–74.0) years, 92.2 (range, 60.1–194.5) mL/min/1.73 m2, and 1386 (range, 160–6678), respectively. A reproductive period of 37–45 years was associated with a lower risk of decreased eGFR (OR: 0.59, 95% CI: 0.35–1.00, p = 0.049) after adjusting for confounding variables. METs decreased the risk of decreased eGFR in women with a reproductive period of 37–45 years (OR: 0.43, 95% CI: 0.23–0.81, p = 0.010). Women with a longer reproductive period have a lower risk of decreased renal function. METs had an opposite influence on renal function in women with longer (decreased risk) or shorter (increased risk) reproductive periods.

The Influence of Indomethacin on Renal Haemodynamics in Sickle Cell Anaemia

1980 ◽  
Vol 59 (4) ◽  
pp. 245-250 ◽  
Author(s):  
P. E. De Jong ◽  
L. T. W. De Jong-Van Den Berg ◽  
G. S. Sewrajsingh ◽  
H. Schouten ◽  
A. J. M. Donker ◽  
...  
Keyword(s):  
Blood Flow ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Renal Blood Flow ◽  
Sickle Cell ◽  
Filtration Rate ◽  
Sickle Cell Anaemia ◽  
Creatinine Excretion ◽  
Urea Excretion ◽  
Urea Reabsorption

1. Glomerular filtration rate and effective renal blood-flow were normal in a series of patients with sickle cell anaemia. Fractional creatinine excretion and fractional urea excretion were increased. 2. During indomethacin administration there were significant falls in glomerular filtration rate, effective renal blood-flow, creatinine clearance and urea clearance in the patients with sickle cell anaemia; fractional urea excretion also fell markedly. In control subjects none of these variables changed after indomethacin. 3. Serum concentration of urea rose markedly during indomethacin administration in sickle cell anaemia, owing to both the decrease in glomerular filtration rate and the increase in fractional urea reabsorption. 4. We conclude that prostaglandins have an important role in maintaining a normal glomerular filtration rate and effective renal blood-flow in sickle cell anaemia. The abnormal urea handling in patients with this disease remains to be elucidated.

MO459RENAL FUNCTION AMONG PATIENTS WITH NEW DIAGNOSIS OF ATRIAL FIBRILLATION - RESULTS FROM THE NATIONWIDE FINACAF- STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Heini Jyrkilä ◽  
Kati Kaartinen ◽  
Leena Martola ◽  
Olli Halminen ◽  
Jari Haukka ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Study Cohort ◽  
Number Of Patients ◽  
Increased Risk ◽  
Combining Data ◽  
The Mean

Abstract Background and Aims Chronic kidney disease (CKD) is a global public health problem with increasing number of patients due to obesity, hypertension, diabetes, and aging. CKD is an independent risk factor for atrial fibrillation (AF) and the incidence of AF in patients with CKD is two- to threefold higher compared to the general population. Relationship between CKD and AF is bidirectional, and the incidence of impaired renal function is higher in patients with AF. Both AF and CKD are associated with increased risk of stroke and systemic thromboembolism, and also bleeding. The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) is a nationwide study among AF patients conducted as a retrospective register-based linkage study combining data from several Finnish health care registers. We aimed to characterize demographics and comorbities of AF patients included in FinACAF according to stages of renal function. Method FinACAF- study collects data from 411 000 patients covering all Finnish AF patients from 1 January 2004 to 31 December 2018. Using national unique personal identification number, individual patients’ data from ten nationwide population registries and six regional laboratory databases (∼282 000, 77% of the patients) are linked together. Inclusion criteria of this substudy were all patients who had new ICD-10 AF diagnosis (code I48) between January 2010 and December 2018 and measured estimated glomerular filtration rate (eGFR) within the proximity of AF the diagnosis. Results Of the whole study cohort, 128 538 were included in this substudy. The mean age at the time of AF diagnosis was 73 years (range 18 to 107 years) and 48.9 % of the patients were female. The age of AF patients increased (Figure 1) and eGFR decreased (Figure 2) in various stages of glomerular filtration at the cohort entry during 2010-2018 are shown in Figures 1 and 2. Prevalence of various comorbidities and the mean age at the baseline are shown in the Table. Most of the comorbidities were more common in patients with lower eGFR levels. Conclusion During 2010-2018 the mean age of new AF patients increased in Finland, and simultaneously the renal function decreased. Also, patients with impaired glomerular filtration rate had more often comorbidities increasing the risk of thromboembolism and bleeding. The findings emphasize appropriate control of these risks in AF patients, especially with reduced renal function.

Evaluation of Renal Function by Glomerular Filtration Rate (GFR) in Infants with Sickle Cell Anemia.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1672-1672
Author(s):  
Winfred C. Wang ◽  
Renee R. Rees ◽  
Daner Li ◽  
Zora Rogers ◽  
Rathi Iyer ◽  
...  
Keyword(s):  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Filtration Rate ◽  
Plasma Clearance ◽  
Renal Damage ◽  
Phase Iii ◽  
Schwartz Equation

Abstract Chronic anemia and intraparenchymal sickling within the kidney lead to intravascular volume expansion and an increased glomerular filtration rate (GFR) in sickle cell anemia (SCA). An elevated GFR is considered to be an early indicator of renal damage in SCA, and the pathophysiologic changes leading to sickle nephropathy and elevated GFR likely begin at a young age. The Pediatric Hydroxyurea Phase III Clinical Trial (BABY HUG), an NHLBI-sponsored multi-center double-blinded placebo-controlled study, compares hydroxyurea versus placebo in infants with SCA, with the primary goal of determining the efficacy of hydroxyurea for the prevention of organ dysfunction in the spleen and kidney. In the Feasibility and Safety Pilot, a primary objective is to assess GFR in infants with SCA between the age of 12 and 18 months by measuring plasma clearance of 99m Tc-DTPA (diethylenetriaminepentaacetic acid) and by estimating GFR using the Schwartz equation. The DTPA GFR was determined following administration of an IV bolus of 25–50 μCi/kg of the radiotracer, with venous blood samples obtained at 1, 2, and 4 hours. GFR was also calculated using the Schwartz equation: 0.55 x body length (cm) ÷ plasma creatinine (mg/dL). For both measurements, a logarithmic transformation was applied to improve linearity between the variables, and to stabilize the variance of the transformed data. To date, 17 infants with SCA (median age 13.2 months) have had GFR measurements, with no complications occurring. The geometric mean of the GFR (± SD) as measured by DTPA plasma clearance was 112 ± 14.6 mL/min/1.73m2 (range 53–178 mL/min/1.73m2). By regression analysis, the GFR was correlated with age, with an increase of approximately 10% per month (univariate p = 0.006, multivariate p = 0.02), and this correlation could not be ascribed to other age-adjusted changes in hemoglobin concentration (p = 0.35), % fetal hemoglobin (HbF, p = 0.67), white blood cell (WBC) count (p = 0.64), or platelet count (p = 0.76). The estimated GFR calculated by the Schwartz equation was not significantly correlated with age (univariate p = 0.12), and adjustments using hemoglobin, %HbF, platelet or WBC counts did not improve the correlation. There was a modest correlation between GFR determined by DTPA and the Schwartz equation (r = 0.44; p = 0.08). These data indicate that (1) GFR measurement using DTPA plasma clearance is feasible in one year-old infants with SCA; (2) renal damage as measured by an elevated DTPA GFR appears to be present early in life and to be increasing with age; (3) preliminary evaluation of the use of the Schwartz formula indicates only a modest level of correlation with results obtained using DTPA measurements; and (4) in the BABY HUG trial, further evaluation of the efficacy of hydroxyurea in preservation of renal function will likely require DTPA GFR measurements rather than GFR estimates using the Schwartz equation.

P391Estimated glomerular filtration rate levels and risk of stroke in individuals with diabetes mellitus and atrial fibrillation

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
R Westreich ◽  
O Barrett ◽  
L Kezerle ◽  
M Leventer Roberts ◽  
M Avgil Tsadok ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Atrial Fibrillation ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Mortality Risk ◽  
Impaired Renal Function ◽  
Filtration Rate ◽  
Historical Cohort ◽  
Increased Risk

Abstract Funding Acknowledgements pfizer Background Diabetes mellitus (DM) is associated with increased risk of embolic complications in non-valvular atrial fibrillation (NVAF). Chronic kidney disease (CKD) has been shown in some studies to increase the risk of stroke. This finding is not consistent among all studies. Therefore the relationship between kidney function, diabetes and stroke risk is complex and warrants further investigation. Purpose To assess the incidence rates and risk of ischemic stroke and mortality by baseline Estimated Glomerular Filtration Rate (eGFR) levels among individuals with AF and DM. Methods A prospective, historical cohort study using our electronic medical records database. The study population included all members 21 years old, with a first diagnosis of NVAF between January 1, 2010 to December 31, 2016 and a minimal follow-up period of 1 year. Among those patients identified as diabetics, we compared three groups of patients according to eGFR levels at the time of AF diagnosis: eGFR ≥ 60, between 30-60 and ≤ 30 or chronic dialysis or kidney transplant. Results A total of  17,567 cases were included in the final analysis, of them, 11013 (62.7%) had eGFR ≥ 60, 4930 (28%) with eGFR between 30-60 and 1624 (9.24%) with eGFR ≤30 . The median age was 75 years (IQR 65-83) with a majority of females in all groups, 52.5%, 51.2% and 55.5% respectively. The incidence of stroke per 100 person-years in the three study groups was: 1.88 in patients with eGFR ≥ 60, 2.69 in patients with eGFR between 30-60 and 3.34 in those with eGFR ≤ 30 . Impaired renal function was associated with increased risk of stroke in univariate analysis, but not found in the adjusted model  (Adjusted Hazard Ratio (AHR) = 1.04 {95% 0.89-1.23} for eGFR 30-60  and 1.16 {95% CI 0.88-1.51} for eGFR ≤ 30 compared to GFR ≥ 60). incidence of mortality per 100 person-years was 10.78 in patients with  eGFR ≥ 60, 21.49 in patients with eGFR 30-60 and 41.55 in those with eGFR ≤ 30. In both univariate and multivariate analyses, decreased levels of eGFR were associated with increased mortality risk compared to subjects with normal renal function (AHR 1.22 {95%CI 1.14-1.27} and AHR 2.09 {95%CI 1.95-2.24} for eGFR between 30-60 and for eGFR ≤ 30, respectively). Conclusion In this observational prospective cohort of patients with newly diagnosed NVAF, impaired renal function was not found to be associated with increased risk of stroke. Lower eGFR levels were associated with an increased mortality risk.

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