The prevalence of hypertension and abnormal kidney function in children with sickle cell disease –a cross sectional review

BMC Nephrology

Katherine MacRae Dell²  John R Sedor²  Mary Ann O’Riordan¹  Alex Huang¹  Prasad Bodas³ 

[1]Department of Pediatrics, Rainbow Babies and Children’s Hospital, Cleveland, OH 44106, USA

[2]CWRU Center for the Study of Kidney Disease and Biology, Case Western Reserve University, Cleveland, OH 44106, USA

[3]Department of Pediatrics, Division of Hematology and Oncology, Akron Children’s Hospital, Akron, OH 44302, USA

关键词: Hypertension;    Chronic kidney disease;    Nephropathy;    Sickle cell disease;   

Others  :  1082802
DOI  :  10.1186/1471-2369-14-237

 received in 2013-06-01, accepted in 2013-10-10,  发布年份 2013

【 摘 要 】

Background

Renal disease is a known contributor to mortality in adults with sickle cell disease (SCD) and renal abnormalities are evident in childhood. Hyperfiltration (evidenced by elevated glomerular filtration rate, GFR) occurs in children with SCD early in disease. However, the incidence of low GFR (<90 ml/min/1.73 m2) suggestive of chronic kidney disease (CKD), is not well established. The prevalence of hypertension is also not well known. The goal of this study was to determine the prevalence of hypertension and CKD in a cohort of children with SCD.

Methods

We performed a retrospective chart review of patients followed at the Rainbow Babies and Children’s Sickle Cell Disease Clinic who were seen during routine follow up visits. Inclusion criteria were all patients ages 3–18. Exclusion criteria included recent (within 2 weeks) hospitalization and/or episode of acute chest, pain crises, febrile illness or red blood cell transfusion. Data collected included serum creatinine, blood pressure and history of sickle cell complications (acute chest syndrome, stroke or stroke risk). Estimated GFR (eGFR) was calculated using the updated Schwartz creatinine-based estimating formula. Analysis examined the associations among eGFR, blood pressure and sickle cell complications. The Institutional Review Board at University Hospitals Case Medical Center approved this study.

Results

A total of 48 children had complete data available. Mean eGFR was 140 mL/min/1.73 m² +/- 34.9 (range 71.9-404.2 mL/min/1.73 m²). Four patients (8.3%) had eGFRs < 90 mL/min/1.73 m², 35 patients (72.9%) had eGFRs > 120 mL/min/1.73 m² and 9 patients (18.8%) had eGFRs in the normal range. Eight patients (16.7%) had evidence of elevated blood pressures (pre-hypertension or hypertension). There was no correlation between eGFR and age, and no association of eGFR with acute chest or stroke risk.

Conclusion

In this SCD cohort, we identified abnormally low eGFR (suggestive of early CKD) in 8.3% of patients and elevated blood pressure in 16.7%. These findings are in contrast to other published studies that show primarily normal or elevated GFR and the absence of or minimal hypertension. These findings indicate that elevated blood pressure and decreased eGFR are not uncommon in children with SCD, and should be more rigorously studied.

【 授权许可】

   
2013 Bodas et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Platt OS, Brambilla DJ, Rosse WF, Milner PF, Castro O, Steinberg MH, Klug PP: Mortality in sickle cell disease. Life expectancy and risk factors for early death. N Engl J Med 1994, 330:1639-1644.
• [2]Powars DR, Elliott-Mills DD, Chan L, Niland J, Hiti AL, Opas LM, Johnson C: Chronic renal failure in sickle cell disease: risk factors, clinical course, and mortality. Ann Intern Med 1991, 115:614-620.
• [3]Scheinman JI: Sickle cell disease and the kidney. Nat Clin Pract Nephrol 2009, 5:78-88.
• [4]Saborio P, Scheinman JI: Sickle cell nephropathy. J Am Soc Nephrol 1999, 10:187-192.
• [5]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, 17:2228-2235.
• [6]Etteldorf JN, Smith JD, Tuttle AH, Diggs LW: Renal hemodynamic studies in adults with sickle cell anemia. Am J Med 1955, 18:243-248.
• [7]Whitten CF, Younes AA: A comparative study of renal concentrating ability in children with sickle cell anemia and in normal children. J Lab Clin Med 1960, 55:400-415.
• [8]Oster JR, Lespier LE, Lee SM, Pellogrini EL, Vaamonde CA: Renal acidification in sickle-cell disease. J Lab Clin Med 1976, 88:389-401.
• [9]Allon M: Renal abnormalities in sickle cell disease. Arch Intern Med 1990, 150:501-504.
• [10]Osegbe DN: Haematuria and sickle cell disease: a report of 12 cases and review of the literature. Trop Geogr Med 1990, 42:22-27.
• [11]Wigfall DR, Ware RE, Burchinal MR, Kinney TR, Foreman JW: Prevalence and clinical correlates of glomerulopathy in children with sickle cell disease. J Pediatr 2000, 136:749-753.
• [12]Ataga K, Orringer E: Renal abnormalities in sickle cell disease. Am J Hematol 2000, 63:205-211.
• [13]Tejani A, Phadke K, Adamson O, Nicastri A, Chen CK, Sen D: Renal lesions in sickle cell nephropathy in children. Nephron 1985, 39:352-355.
• [14]Adams R, McKie V, Nichols F, Carl E, Zhang D, McKie K, Figueroa R, Litaker M, Thompson W, Hess D: The use of transcranial ultrasonography to predict stroke in sickle cell disease. N Engl J Med 1992, 326:605-610.
• [15]Schwartz GJ, Furth SL: Glomerular filtration rate measurement and estimation in chronic kidney disease. Pediatr Nephrol 2007, 22:1839-1848.
• [16]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, 58:259-263.
• [17]Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL: New equations to estimate GFR in children with CKD. J Am Soc Nephrol 2009, 20:629-637.
• [18]Staples A, Leblond R, Watkins S, Wong C, Brandt J: Validation of the revised Schwartz estimating equation in a predominantly non-CKD population. Pediatr Nephrol 2010, 25:2321-2326.
• [19]National High Blood Pressure Education Program (US): The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Bethesda (MD): National Heart, Lung, and Blood Institute (US); 2005:48. [Rev. ed] NIH publication; no. 05–5267
• [20]Yee M, Jabbar SF, Osunkwo I, Clement L, Lane PA, Eckman JR, Guasch A: Chronic kidney disease and albuminuria in children with sickle cell disease. Clin J Am Soc Nephrol 2011, 6:2628-2633.
• [21]Genovese G, Friedman DJ, Ross MD, Lecordier L, Uzureau P, Freedman BI, Bowden DW, Langefeld CD, Oleksyk TK, UscinskiKnob AL, Bernhardy AJ, Hicks PJ, Nelson GW, Vanhollebeke B, Winkler CA, Kopp JB, Pays E, Pollak MR: Association of trypanolytic ApoL1 variants with kidney disease in African Americans. Science 2010, 329:841-845.
• [22]Ashley-Koch AE, Okocha EC, Garrett ME, Soldano K, De Castro LM, Jonassaint JC, Orringer EP, Eckman JR, Telen MJ: MYH9 and APOL1 are both associated with sickle cell disease nephropathy. Br J Haematol 2011, 155:386-394.
• [23]Aaronson IA, Mann MD: Measurement of glomerular filtration rate in children using technetium-99m diethylenetri- amine penta-acetic acid. S Afr Med J 1985, 67:507-509.
• [24]Notghi A, Merrick MV, Ferrington C, Anderton JL: A comparison of simplified and standard methods for the measurement of glomerular filtration rate and renal tubular function. Br J Radiol 1986, 59:35-39.
• [25]Russell CD, Bischoff CG, Rowell KL, Kontzen F, Lloyd LK, Tauxe WN, Dubovsky EV: Quality control of Tc-99m DTPA for measurement of glomerular filtration: concise communication. J Nucl Med 1983, 24:722-727.
• [26]Perrone RD, Steinman TI, Beck GJ, Skibinsky CI, Royal HD, Lawlor M, Hunsicker LG: Utility of radioisotopic filtration markers in chronic renal insufficiency: Simultaneous comparison of 125I-Iothalamate, 169Yb-DTPA, 99mTc-DTPA, and inulin. The Modification of Diet in Renal Disease Study. Am J Kidney Dis 1990, 16:224-235.
• [27]Rodman J, Maneval D, Magill L, Sunderland M: Measurement of Tc99m DTPA serum clearance for estimating glomerular filtration rate in children with cancer. Pharmacotherapy 1993, 13:10-16.
• [28]Rehling M, Moller ML, Thamdrup B, Lund JO, Trap-Jensen J: Simultaneous measurement of renal clearance and plasma clearance of 99mTc- labelled diethylenetriaminepenta-acetate, 51Cr-labelled ethylenediaminetetraacetate and inulin in man. Clin Sci 1984, 66:613-619.
• [29]Aygun B, Mortier NA, Smeltzer MP, Hankins JS, Ware RE: Glomerular hyperfiltration and albuminuria in children with sickle cell anemia. Pediatr Nephrol 2011, 26:1285-1290.
• [30]Imuetinyan BA-I, Okoeguale MI, Egberue GO: Microalbuminuria in children with sickle cell anemia. SJKDT 2011, 22:733-738.
• [31]Sorof JM, Lai D, Turner J, Poffenbarger T, Portman RJ: Overweight, ethnicity, and the prevalence of hypertension in school-aged children. Pediatrics 2004, 113:475-482.
• [32]Shatat IF, Jakson SM, Blue AE, Johnson MA, Orak JK, Kalpatthi R: Masked hypertension is prevalent in children with sickle cell disease: a Midwest pediatric nephrology consortium study. Pediatr Nephrol 2012, 28:115-120.
• [33]Mitsnefes M, Flynn J, Cohn S, Samuels J, Blydt-Hansen T, Saland J, Kimball T, Furth S, Warady B, for the CKiD Study Group: Masked hypertension associates with left ventricular hypertrophy in children with CKD. J Am Soc Nephrol 2010, 21:137-144.
• [34]Becton LJ, Kalpatthi RV, Rackoff E, Disco D, Orak JK, Jackson SM, Shatat IF: Prevalence and clinical correlates of microalbuminuria in children with sickle cell disease. Pediatr Nephrol 2010, 25:1505-1511.
• [35]de Boer IH, Rue TC, Cleary PA, Lachin JM, Molitch ME, Steffes MW, Sun W, Zinman B, Brunzell JD, White NH, Danis RP, Davis MD, Hainsworth D, Hubbard LD, Nathan DM: Long-term renal outcomes of patients with type 1 diabetes mellitus and microalbuminuria: an analysis of the diabetes control and complications trial/epidemiology of diabetes interventions and complications cohort. Arch Intern Med 2011, 171:412-420.
• [36]Schwartz GJ, Lerner NB: The kallikrein-kinin system in sickle cell nephropathy: does it play a role? J Pediatr Hematol Oncol 2006, 28:111-114.
• [37]Bergmann S, Zheng D, Barredo J, Abboud M, Jaffa A: Renal kallikrein: a risk marker for nephropathy in children with sickle cell disease. J Pediatr Hematol Oncol 2006, 28:147-153.
• [38]Mohtat D, Thomas R, Du Z, Boakye Y, Moulton T, Driscoll C, Woroniecki R: Urinary transforming growth factor beta-1 as a marker of renal dysfunction in sickle cell disease. Pediatr Nephrol 2011, 26:275-280.
• [39]Tharaux P, Hagege I, Placier S, Vayssairat M, Kanfer A, Girot R, Dussaule J: Urinary endothelin-1 as a marker of renal damage in sickle cell disease. Nephrol Dial Transplant 2005, 20:2408-2413.
• [40]Sundaram N, Bennett M, Wilhelm J, Kim M-O, Atweh G, Devarajan P, Malik P: Biomarkers for early detection of sickle nephropathy. Am J Hematol 2011, 86:559-566.
• [41]Lu L, Sedor JR, Gulani V, Schelling JR, O’Brien A, Flask CA, MacRae Dell K: Use of diffusion tensor MRI to identify early changes in diabetic nephropathy. Am J Nephrol 2011, 34:476-482.