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Prevalence and Correlates of Microalbuminuria in Children with Sickle Cell Anaemia: Experience in a Tertiary Health Facility in Enugu, Nigeria  [PDF]
Christopher Bismarck Eke,Henrietta Uche Okafor,Bede Chidozie Ibe
International Journal of Nephrology , 2012, DOI: 10.1155/2012/240173
Abstract: Microalbuminuria is a pre-clinical marker of renal damage in children with sickle cell anaemia and can predict renal failure. Reported prevalence rates increased with age. In Nigeria, burden of disease and prevailing poor health facilities necessitate its screening, determination of prevalence and associated risk factors. It is a cross-sectional as well as descriptive study. Screening microalbuminuria used subjects’ early morning urine. Socio-demographic as well as clinical details were ascertained using semi-structured questionnaires and case files. Associations and statistical relationship of prevalence rates and clinical/epidemiological data were ascertained using chi-squared and multivariate analysis . Two hundred children with sickle cell anaemia (4–17 years) in steady state and 200 age/gender-matched controls were enrolled. Prevalence of microalbuminuria was ,respectively, 18.5% and 2.5% for subjects and controls . Microalbuminuria was commoner in females (19.8%) than males (17.4%) , increased with age , significantly associated with haemoglobin level and hospitalizations (0.001). Subjects had normal renal function. Hospitalizations and haemoglobin levels showed statistical significance on multivariate analysis. Prevalence of microalbuminuria is 18.5%. Age, haemoglobin concentrations, and higher hospitalizations influenced microalbuminuria among subjects. Screening for microalbuminuria should be incorporated in the case management of subjects with identified risk factors. 1. Introduction Sickle cell nephropathy is a major complication of sickle cell disease and results from recurrent renal vasoocclusion, ischaemia-reperfusion injury, and loss of renal mass [1]. It is characterized by glomerular hypertrophy and focal glomerulosclerosis [2, 3]. Proteinuria is one of the most common clinical manifestations of sickle cell nephropathy [4, 5]. Lowest level of albuminuria (20–200?mg/L) known as microalbuminuria [6] is a preclinical marker of glomerular damage predicting progressive renal failure in conditions like diabetes mellitus also associated with hyperfiltration, and hyperperfusion [7]. Microalbuminuria has been defined as an abnormally or supranormal urinary excretion of albumin in the absence of clinical proteinuria (i.e., proteinuria detectable by use of conventional dipstick like Albustix) [8]. Marshall et al. [9] defined microalbuminuria in terms of timed overnight urine collection as an albumin excretion rate greater than 20?μg per minute. Various proportional rates of microalbuminuria have been reported in children with sickle cell anaemia
Prevalence of Microalbuminuria among secondary school children
AN Okpere, IC Anochie, FU Eke
African Health Sciences , 2012,
Abstract: Background: Microalbuminuria is an early sign of kidney and cardiovascular damage. Therefore, early detection in asymptomatic individuals may be helpful in preventing deterioration in renal function. Methods: We carried out a cross-sectional study of 820 secondary school students aged 10 – 19 years from September to November 2008. The urine samples of 615 (75.0%) without overt proteinuria and haematuria were tested for microalbuminuria using the micral test strips. Values of greater than 20mg/L were considered positive. Results: There were 299 (48.6%) males and 316 (51.4%) females, with a M:F ratio of 1:1.1. The prevalence of microalbuminuria as seen in 214 of the students was 33.2%. It was significantly higher in females (45.3%), obese subjects (35.4%), those with hypertension (70.6%), those with positive family history of hypertension (59.5%), and diabetes mellitus (46.4%). Microalbuminuria was found in 1 of the 2 subjects who had features of DM and in one subject with sickle cell anemia. Conclusion: The prevalence of microalbuminuria in Nigerian adolescents is high. We recommend routine screening for microalbuminuria in adolescents for early detection and prevention of renal damage.
Combination of Haemoglobinopathy and Haemopathy
—(Adult T-Cell Lymphoma/Leukemia and Sickle Cell Disease: A Rare Case of Disease Observed in the Adult Referral Center of Sickle Cell Disease (CRD-A) in Martinique
 [PDF]

Daouda Kone, Nicaise Yao Atimere, Line Couitchere, Gyna Loko
Open Journal of Blood Diseases (OJBD) , 2017, DOI: 10.4236/ojbd.2017.74010
Abstract:
Authors report a case of beta thalassemia combined with hematological malignant (ATLL) in a 40-year-old female, cashier screened HTLV-1 positive; followed since her 10 years old for the account of thalasso-sickle cell disease at the adult referal center of sickle cell disease in Martinique. Therapeutic management consisted of systemic chemotherapy, intrathecally-administered preventive chemotherapy combined with a treatment based on bisphosphonate and corticosteroid.
Renal dysfunction in patients with sickle cell anemia or sickle cell trait
Sesso, R.;Almeida, M.A.;Figueiredo, M.S.;Bordin, J.O.;
Brazilian Journal of Medical and Biological Research , 1998, DOI: 10.1590/S0100-879X1998001000004
Abstract: patients with sickle cell anemia (hb ss) or sickle cell trait (hb as) may present several types of renal dysfunction; however, comparison of the prevalence of these abnormalities between these two groups and correlation with the duration of disease in a large number of patients have not been thoroughly investigated. in a cross-sectional study using immunoenzymometric assays to measure tubular proteinuria, microalbuminuria, measurement of creatinine clearance, urinary osmolality and analysis of urine sediment, we evaluated glomerular and tubular renal function in 106 adults and children with hb ss (n = 66) or hb as (n = 40) with no renal failure (glomerular filtration rate (gfr) >85 ml/min). the percentage of individuals with microalbuminuria was higher among hb ss than among hb as patients (30 vs 8%, p<0.0001). the prevalence of microhematuria was similar in both groups (26 vs 30%, respectively). increased urinary levels of retinol-binding protein or ?2-microglobulin were detected in only 3 hb ss and 2 hb as patients. urinary osmolality was reduced in patients with hb ss or with hb as; however, it was particularly evident in hb ss patients older than 15 years (median = 393 mosm/kg, range = 366-469) compared with hb as patients (median = 541 mosm/kg, range = 406-722). thus, in addition to the frequently reported early reduction of urinary osmolality and increased gfr, nondysmorphic hematuria was found in 26 and 30% of patients with hb ss or hb as, respectively. microalbuminuria is an important marker of glomerular injury in patients with hb ss and may also be demonstrated in some hb as individuals. significant proximal tubular dysfunction is not a common feature in hb ss and hb as population at this stage of the disease (i.e., gfr >85 ml/min).
Renal dysfunction in patients with sickle cell anemia or sickle cell trait  [cached]
Sesso R.,Almeida M.A.,Figueiredo M.S.,Bordin J.O.
Brazilian Journal of Medical and Biological Research , 1998,
Abstract: Patients with sickle cell anemia (Hb SS) or sickle cell trait (Hb AS) may present several types of renal dysfunction; however, comparison of the prevalence of these abnormalities between these two groups and correlation with the duration of disease in a large number of patients have not been thoroughly investigated. In a cross-sectional study using immunoenzymometric assays to measure tubular proteinuria, microalbuminuria, measurement of creatinine clearance, urinary osmolality and analysis of urine sediment, we evaluated glomerular and tubular renal function in 106 adults and children with Hb SS (N = 66) or Hb AS (N = 40) with no renal failure (glomerular filtration rate (GFR) >85 ml/min). The percentage of individuals with microalbuminuria was higher among Hb SS than among Hb AS patients (30 vs 8%, P<0.0001). The prevalence of microhematuria was similar in both groups (26 vs 30%, respectively). Increased urinary levels of retinol-binding protein or 2-microglobulin were detected in only 3 Hb SS and 2 Hb AS patients. Urinary osmolality was reduced in patients with Hb SS or with Hb AS; however, it was particularly evident in Hb SS patients older than 15 years (median = 393 mOsm/kg, range = 366-469) compared with Hb AS patients (median = 541 mOsm/kg, range = 406-722). Thus, in addition to the frequently reported early reduction of urinary osmolality and increased GFR, nondysmorphic hematuria was found in 26 and 30% of patients with Hb SS or Hb AS, respectively. Microalbuminuria is an important marker of glomerular injury in patients with Hb SS and may also be demonstrated in some Hb AS individuals. Significant proximal tubular dysfunction is not a common feature in Hb SS and Hb AS population at this stage of the disease (i.e., GFR >85 ml/min).
Association of Oxidative Stress Markers with Atherogenic Index of Plasma in Adult Sickle Cell Nephropathy  [PDF]
M. A. Emokpae,P. O. Uadia
Anemia , 2012, DOI: 10.1155/2012/767501
Abstract: This paper evaluates the association of oxidative stress and atherogenic index of plasma in order to assess the cardiovascular risk in Sickle cell nephropathy especially as lipoprotein levels are lower in SCD than non-SCD patients. Antioxidant enzymes, malondialdehyde(MDA), urea, creatinine, and glomerular filtration rate were evaluated in 110 confirmed sickle cell disease patients: 65 males in steady state, aged years, 30 males with macroalbuminuria, aged , years and 15 with chronic kidney disease (CKD), aged years. The mean activity levels of glutathione peroxidase (GPx), superoxide dismutase (Cu/ZnSOD), and catalase (CAT) were significantly lower ( ) in SCD with macroalbuminuria and CKD while MDA was higher ( ) in SCD with macroalbuminuria and CKD compared with controls. There was negative correlation between GPx ( ), Cu/ZnSOD ( ), and Atherogenic index of plasma in SCD with CKD, while MDA shows a positive correlation ( ) with AIP in SCD with CKD. There was however no correlation between CAT and AIP. Decreased activity levels of antioxidant enzymes and low HDL-cholesterol concentration were confirmed in adult SCD with CKD in Nigerians. The increase oxidative stress and high atherogenic index in CKD may accelerate the process of cardiovascular complications in adult SCD patients. Atherogenic index of plasma was negatively correlated with antioxidant enzymes and positively with MDA. 1. Introduction Sickle cell disease (SCD) is a haemoglobinopathy which is characterized by red blood cell rigidity, compromised perfusions, and tissue infarction [1]. The kidney of patients with SCD is affected both by haemodynamic changes of chronic and by consequences of vaso-occlusion within the renal medulla [2, 3]. Renal abnormalities in structure and function occur with increasing age of subject with SCD. The pathogenesis of SCD is due to polymerization of sickle red blood cell causing chronic haemolytic anaemia, vaso-occlusive crisis, and intravascular haemolysis. Sickle cell disease patients are susceptible to increased oxidative stress due to constant haemolysis of mutant red blood cells since haemoglobin acts as powerful catalyst for initiation of peroxidative reaction [4, 5]. Proteinuria is common in adult patients with SCD and we earlier reported a 28% prevalence of proteinuria in this group of patients in Nigeria [6]. Proteinuria is a progression factor in chronic kidney disease heralding a further deterioration in renal function [6]. Metabolic abnormalities, inflammation, and ischaemia may increase oxidative stress in sickle cell nephropathy (SCN). Increased
Microalbuminuria en adolescentes obesos
Pi?eiro Lamas,Regino; Callejas de la Pe?a,Karina; Pacheco Torres,Larisa; Duarte,María Caridad; Valdés Alonso,María del Carmen; Martínez Martínez,Ronelsis;
Revista Cubana de Pediatr?-a , 2009,
Abstract: introduction: the high prevalence of obesity in adolescents increases the renal damage at this age. the aim of present paper was to know the presence of microalbuminuria in obese adolescents and its relation with some clinical and biochemical variants that may be risk factors of renal damage. methods: we studied 57 obese adolescents of both sexes aged between 10 and 15. we made two microalbuminuria studies, as well as glycemia, insulin, total cholesterol, and fast triglycerides. results: microalbuminuria was positive in more than half of study obese adolescents explaining presence of a glomerular damage. there was a representativeness of positive microalbuminuria in ages from 13 to 15 years alike the sex. course time and obesity severity have not influence on microalbuminuria. in spite of that 11 of 18 patients presenting arterial hypertension had also microalbuminuria (61, 1%), there was not a significant relation with microalbuminuria. dyslipemia and insulin-resistance influenced significantly in microalbuminuria. conclusions: presence of microalbuminuria was observed in more than half of patients presenting metabolic syndrome, suggesting that it is an important component in such syndrome. it is necessary to study of microalbuminuria in all obese adolescents.
Alteraciones renales en la drepanocitosis Renal disorders in sickle cell disease
Aramís Nú?ez-Quintana,Norma I Hondal-álvarez,Lucía Ayllón-Valdés
Revista Cubana de Hematolog?-a, Inmunolog?-a y Hemoterapia , 2011,
Abstract: La drepanocitosis está asociada con un amplio espectro de alteraciones renales que tienen su base en la falciformación de los eritrocitos en los vasos de la médula renal, que conduce a fenómenos de isquemia, microinfartos y anomalías de la función tubular. Se producen también alteraciones glomerulares funcionales reversibles de la autorregulación renal (hiperfiltración), que pueden conducir a cambios anatómicos irreversibles con glomeruloesclerosis segmentaria focal. Estas anomalías se expresan tempranamente como microalbuminuria, proteinuria y de forma mas tardía, como síndrome nefrótico e insuficiencia renal crónica. Medidas terapéuticas como el uso de inhibidores de la enzima convertidora de la angiotensina II, de los bloqueadores del receptor de la angiotensina II, asociados o no con la hidroxiurea, pueden prevenir o retardar el da o glomerular. En el presente trabajo se exponen de forma resumida aspectos relacionados con la fisiopatología del da o renal en la drepanocitosis y su tratamiento. Sickle cell disease is associated with a wide range of renal disorders resulting from the falciformation of erythrocytes in vessels of the renal medulla, leading to ischemia, microinfarctions and tubular function abnormalities. Reversible glomerular functional renal self-regulation disorders (hyperfiltration) also occur, which may lead to irreversible anatomical changes with focal segmental glomerular sclerosis. These anomalies are expressed at an early stage as microalbuminuria and proteinuria, and at a later stage as nephrotic syndrome and chronic renal failure. Therapeutic measures such as the use of angiotensin-II converting enzyme inhibitors and angiotensin-II receptor blockers, associated or not with hydroxyurea, may either prevent or delay glomerular damage. The paper succinctly presents the physiopathology of renal damage in drepanocytosis and its treatment.
Evaluation of Microalbuminuria 4 to 6 Years Following Type 1 Diabetes and its Correlation to Glycemic Control in Children
A Derakhshan,M Akhavan,H Karamifar
Iranian Journal of Pediatrics , 2007,
Abstract: Objective: Diabetic nephropathy is one of the major complications and a leading cause of mortality and morbidity in diabetes mellitus. Microalbuminuria is the earliest sign of diabetic nephropathy and it is highly related to glycemic control. Progression of diabetic nephropathy is mostly asymptomatic until advanced stages of renal failure. In this study microalbuminuria and its correlation with duration of diabetes and quality of diabetes control (HbA1c level) is evaluated in 50 children with type 1 diabetes mellitus.Material & Methods: Fifty children 4 to 6 years following the onset of type 1 diabetes, below 20 years of age, were enrolled in this study. Twenty four hrs urine was checked twice within 3 to 6 months period for microalbuminuria by nephelometry method and values >30 mg/24hrs were considered abnormal. Also HbA1c level and FBS level assessed simultaneously. Mean FBS level during the years of diabetes and number of attacks of DKA wereFindings: Fifty children, 4 to 19 years old with mean age of 14.54 ± 3.62 years, 28 (56%) males completed the study. Nineteen (38%), 14 (28%) and 17 (34%) children enrolled in this study 4, 5, 6 years after the onset of their diabetes respectively. At 1st evaluation microalbuminuria was detected in 5 (26.3%), 4 (28.6%) and 6 (35.3%) children, 4, 5, 6 years after diabetes respectively. At 2nd evaluation these values were 4 (21.1%), 6 (42.9%) and 7 (41.2%) respectively. There was no significant correlation between HbA1c level, FBS level, and mean FBS level during the years of diabetes in microalbuminuric and non-microalbuminuric children.Conclusion: Despite small sample size of this study, microalbuminuria was detected in children even 4 years after the onset of diabetes and its frequency increased in children with 5 and 6 years of diabetes. We recommend earlier than usual recommendations for microalbuminuria screening in diabetic children.
Compound Heterozygous Sickle and Thalassemia Trait: A Case Report  [PDF]
Bikash Shrestha,Kavita Karmacharya,Jasjit Singh,Jyoti Kotwal,Amit Devgan
Journal of Nepal Paediatric Society , 2011, DOI: 10.3126/jnps.v31i2.4414
Abstract: Sickle cell disease is a type of hemoglobinopathy, which is fairly common in certain parts of the world. We would like to report an interesting case of a child who was labeled as sickle cell anemia but subsequently turned out to be a case of compound heterozygous sickle cell and thalassemia trait. Keywords: Sickle cell disease; haemoglobinopathy; thalassemia; hydroxyurea; globin; electrophoresis; HPLC DOI: 10.3126/jnps.v31i2.4414 J Nep Paedtr Soc 2010;31(2):130-133
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