Glomerular hyperfiltration in adult sickle cell anemia: a frequent hemolysis associated feature | oneSCDvoice
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scientific articles

Glomerular hyperfiltration in adult sickle cell anemia: a frequent hemolysis associated feature

key information

source: Clinical Journal of the American Society of Nephrology

year: 2010

authors: Haymann JP, Stankovic K, Levy P, Avellino V, Tharaux PL, Letavernier E, Grateau G, Baud L, Girot R, Lionnet F

summary/abstract:

BACKGROUND AND OBJECTIVES:
Sickle cell anemia-associated nephropathy is a growing matter of concern because renal failure affects most aging sickle cell anemia patients. Glomerular damage is a common feature revealed by a microalbuminuria or a macroalbuminuria. Although glomerular hyperfiltration has been described for decades in this population, its prevalence in young adults is unknown.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:
To address this issue, as well as the clinical and biologic correlates of hyperfiltration, a single-center, cross-sectional study of 280 homozygous SS disease patients was performed.

RESULTS:
The prevalence of hyperfiltration assessed by Modification of Diet in Renal Disease estimated GFR was 51%. Among patients with hyperfiltration, 49% had hyperfiltration alone, whereas 36% and 15% had an associated microalbuminuria or macroalbuminuria, respectively. Estimated GFR sensitivity and specificity for hyperfiltration were 94% and 63%, respectively, in a selected subgroup of 48 patients (measured GFR was assessed by urinary (51)Cr EDTA clearance). In patients with no albuminuria, hyperfiltration status was significantly associated with a young age (years), the absence of alpha thalassemia, a lower hemoglobin level (g/dl), and a lower fetal hemoglobin. The role of chronic hemolysis was further strengthened by multivariate analysis showing a correlation between estimated GFR and a low plasma fetal hemoglobin level, a young age, and a high reticulocyte count (r(2) = 0.54).

CONCLUSIONS:
Together, the data suggest that the pathophysiology of hyperfiltration would rather be attributable to the hemolysis-associated vasculopathy rather than a viscosity-vaso-occlusive process.

organisation: Université Pierre et Marie Curie, Université Paris, Institut National de la Santé et de la Recherche Médicale Unit, Paris, France

DOI: 10.2215/CJN.08511109

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