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Glomerular hyperfiltration in adult sickle cell anemia: a frequent hemolysis associated feature.
Clin J Am Soc Nephrol. 2010 May; 5(5):756-61.CJ

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.

Authors+Show Affiliations

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.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20185605

Citation

Haymann, Jean-Philippe, et al. "Glomerular Hyperfiltration in Adult Sickle Cell Anemia: a Frequent Hemolysis Associated Feature." Clinical Journal of the American Society of Nephrology : CJASN, vol. 5, no. 5, 2010, pp. 756-61.
Haymann JP, Stankovic K, Levy P, et al. Glomerular hyperfiltration in adult sickle cell anemia: a frequent hemolysis associated feature. Clin J Am Soc Nephrol. 2010;5(5):756-61.
Haymann, J. P., Stankovic, K., Levy, P., Avellino, V., Tharaux, P. L., Letavernier, E., Grateau, G., Baud, L., Girot, R., & Lionnet, F. (2010). Glomerular hyperfiltration in adult sickle cell anemia: a frequent hemolysis associated feature. Clinical Journal of the American Society of Nephrology : CJASN, 5(5), 756-61. https://doi.org/10.2215/CJN.08511109
Haymann JP, et al. Glomerular Hyperfiltration in Adult Sickle Cell Anemia: a Frequent Hemolysis Associated Feature. Clin J Am Soc Nephrol. 2010;5(5):756-61. PubMed PMID: 20185605.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Glomerular hyperfiltration in adult sickle cell anemia: a frequent hemolysis associated feature. AU - Haymann,Jean-Philippe, AU - Stankovic,Katia, AU - Levy,Pierre, AU - Avellino,Virginie, AU - Tharaux,Pierre-Louis, AU - Letavernier,Emmanuel, AU - Grateau,Gilles, AU - Baud,Laurent, AU - Girot,Robert, AU - Lionnet,François, Y1 - 2010/02/25/ PY - 2010/2/27/entrez PY - 2010/2/27/pubmed PY - 2010/8/13/medline SP - 756 EP - 61 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 5 IS - 5 N2 - 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. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/20185605/Glomerular_hyperfiltration_in_adult_sickle_cell_anemia:_a_frequent_hemolysis_associated_feature_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=20185605 DB - PRIME DP - Unbound Medicine ER -