SP135RENAL INVOLVEMENT IN SICKLE CELL DISEASE IN TRIBAL WESTERN INDIA

Abstract

Introduction and Aims: Sickle cell disease (SCD) is the most common hemoglobinopathy. Renal abnormalities in SCD are well known and include urinary concentration defect, acidification defect, renal papillary necrosis and proteinuria related to glomerular injury leading to chronic kidney disease. North Maharashtra in India is considered as a sickle belt and strict practice of endogamy in all social ranks may be a reason for its common occurrence in this region. The study is undertaken to assess the renal involvement in sickle cell disease patients. Methods: This is a prospective observational study involving 65 patients of SCD from November 2013 to July 2014. All patients underwent evaluation of renal function and urine examination to detect proteinuria and other urinary abnormalities. Estimation of glomerular filtration rate (GFR) was done by the criteria of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Results: The patient population consisted of 30 males (46.2%) and 35 females (53.8%). The median age was 21 years (Range: 10-37 years). Glomerular hyperfiltration was present in 15 patients (23%), while low GFR (less than 60ml/min/1.73m2) was found in 9 patients (13.8%). Of the patients with low GFR, rise in creatinine was seen in only 4 patients. Microalbuminuria (30-300 mg/day) was seen in 20 patients (30.8%) and macroalbuminuria (more than 300 mg/day) in 5 patients (7.7%). Microscopic hematuria was detected in 16 patients (24.6%) and hemoglobinuria 6 patients (9.2%). Hyperkalemia was observed in 9 patients (13.8%) and all had urinary concentrating defect. The comparison between patients according to GFR and hematological parameters showed that patients with hyperfiltration were younger, high hemoglobin and lower creatinine levels while patients with low GFR were elder, anemic and renal dysfunction. Conclusions: Renal involvement in SCD is common with proteinuria (microscopic and macroscopic) being the commonest abnormality. Though GFR decreases, serum creatinine may remain low suggesting to take precautions while using analgesics. Considering these abnormalities, routine screening of SCD patients is indicated to prevent further progression of renal disease.