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Clin J Am Soc Nephrol. 2010 May;5(5):756-61. doi: 10.2215/CJN.08511109. Epub 2010 Feb 25.

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

Author information

1
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

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.

Comment in

PMID:
20185605
PMCID:
PMC2863976
DOI:
10.2215/CJN.08511109
[Indexed for MEDLINE]
Free PMC Article

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