Document Detail


Glomerular hyperfiltration in adult sickle cell anemia: a frequent hemolysis associated feature.
MedLine Citation:
PMID:  20185605     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Jean-Philippe Haymann; Katia Stankovic; Pierre Levy; Virginie Avellino; Pierre-Louis Tharaux; Emmanuel Letavernier; Gilles Grateau; Laurent Baud; Robert Girot; François Lionnet
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Publication Detail:
Type:  Journal Article     Date:  2010-02-25
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  5     ISSN:  1555-905X     ISO Abbreviation:  Clin J Am Soc Nephrol     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-05-10     Completed Date:  2010-08-12     Revised Date:  2011-07-28    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  756-61     Citation Subset:  IM    
Affiliation:
Université Pierre et Marie Curie, Université Paris 6, Institut National de la Santé et de la Recherche Médicale Unit 702, Physiology, Paris, France. jean-philippe.haymann@tnn.aphp.fr
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Albuminuria / blood,  epidemiology*,  physiopathology
Anemia, Sickle Cell / blood,  epidemiology*,  genetics,  physiopathology
Cross-Sectional Studies
Female
France / epidemiology
Glomerular Filtration Rate*
Hemoglobin, Sickle / genetics
Hemolysis*
Homozygote
Humans
Kidney / physiopathology*
Linear Models
Logistic Models
Male
Middle Aged
Prevalence
Renal Insufficiency / blood,  epidemiology*,  genetics,  physiopathology
Risk Assessment
Risk Factors
Young Adult
Chemical
Reg. No./Substance:
0/Hemoglobin, Sickle
Comments/Corrections
Comment In:
Clin J Am Soc Nephrol. 2010 May;5(5):748-9   [PMID:  20299367 ]

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