The prevalence of Sickle Nephropathy among children with Sickle Cell Disease

Background: Children with SCD might be at higher risk of progressive renal damage. Hyperfiltration and microalbuminuria are the main criteria of early sickle nephropathy. Urine albumin to creatinine ratio (ACR) is an effective screening tool for detection of sickle nephropathy.Objective: to assess the prevalence of sickle nephropathy among children with sickle cell anemia using Urine albumin to creatinine ratio (ACR).Methods: This study included 23 children with HbSS (SCA) and 22 patients with HbS beta 0 thalassemia of age 1 to 18 years; forty-five apparently healthy children of comparable age and sex were taken as a control group. All patients were in steady state and had normal kidney functions. All subjects were subjected to full clinical assessment and urine ACR measurements.Results: The study group showed male sex predominance (m/f ratio 3:2). They were aged 1 to 18 years old with mean age 11.0 +/- 3.5 years. Their Mean age at diagnosis was 1.33 +/- 1.02 years in homozygous SS patients and 1.46 years +/- 1.07 years in SB thalassemia patients. Thirty-eight (86%) patients had history of consanguineous marriage and 25 (55.5%) had similar condition in the family. The frequency of CNS vasculopathy among the study group was 20%. Microalbuminuria was present in 33.33% of all study subjects. Seven out of 23 homozygous SS children had microalbuminuria (30.4%) vs. 8 out of 22 with SB-thalassemia (36.4%). Mean ACR was twice higher in the study group compared with the control group (p = 0.002). Mean urine specific gravity was 1019.08 +/- 4.17mg/g creat in SS group vs. 1017.14 +/- 5.16 in SB thalassemia group (p=0.170). Mean A/C ratio was 25.56 +/- 20.95 mg/g among sickle SS group of patients vs. 31.09 +/- 30.91 among sickle beta thalassemia group of patients (p=0.617)Conclusions: ACR is higher in children with SCD than in controls. Microalbuminuria is a common finding in children with SCD. Children with SB-thalassemia might be at higher risk of sickle nephropathy.