Proteinuria in adults with sickle-cell disease: the role of hydroxycarbamide(hydroxyurea) as a protective agent
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Background Renal abnormalities are often seen in sickle cell disease (SCD). Objective To investigate the role of hydroxycarbamide as a protective agent in sickle cell nephropathy. Setting Patients with SCD followed at a Hematology outpatients clinic. Methods Prospective study with 26 SCD patients. Renal function evaluation was performed and a comparison between patients and control group was done. Patients using hydroxycarbamide were compared to those not taking this drug. Main outcome measure Effect of hydroxycarbamide on renal function. Results Patients mean age was 32.1 ± 9.9 years, and 16 (61 %) were males. Glomerular hyperfiltration was found in nine patients with SCD (34.6 %). GFR < 60 mL/min/1.73 m2 was observed in three cases (11.5 %). Microalbuminuria (30–300 mg/day) was found in seven cases (27 %) and macroalbuminuria (>300 mg/dia) in one patient (3.8 %). All patients had urinary concentrating deficit, and inability to acidify urine was found in ten cases (38.4 %). The comparison of patients according to the use of hydroxycarbamide showed lower levels of serum creatinine in those using the drug (0.6 ± 0.1 vs. 0.8 ± 0.3 mg/dL, p = 0.03), as well as lower levels of 24 h-proteinuria (226 ± 16 vs. 414 ± 76 mg/dL, p = 0.0001), but not microalbuminuria (79 ± 15 vs. 55 ± 86 mg/dL, p = 0.35). Conclusion SCD is associated with important renal abnormalities. Hydroxycarbamide seems to protect kidney function in SCD by decreasing proteinuria but not microalbuminuria.
KeywordsHydroxycarbamide Kidney disease Proteinuria Renal function tests Sickle cell disease Tubular dysfunction
We are very grateful to the team of physicians, residents, medical students, and nurses from the Walter Cantídio University Hospital, Federal University of Ceará, for providing technical support for the development of this research and for the exceptional assistance provided to the patients.
Prof. E.F.D., A.M.C.M. and A.B.L. received a grant from the Brazilian Research Council (Conselho Nacional de Desenvolvimento Científico e Tecnológico—CNPq, bolsa de produtividade em pesquisa).
Conflicts of interest
- 2.Josephs H. Clinical aspects of sickle cell anemia. Bull Johns Hopkins Hosp. 1928;43:397–8.Google Scholar
- 8.Wang WC. Sickle cell anemia and other sickling syndromes. In: Greer JP, Foerster J, Rodgers GM, Paraskevas F, Glader B, Arber DA, Means Jr RT. Wintrobe’s clinical hematology, 12th edition. Philadelphia: Lippincott Williams and Wilkins, p. 1038–1082, 2009. ISBN: 978-0-7817-6507-7Google Scholar
- 9.Saunthararajah Y, Vichinsky EP. Sickle cell disease—clinical features and management. In: Hoffman—Hematology: basic principles and practice. Oxford: Churchill Livingstone, 5th edn, p. 577–601, 2008. ISBN: 978-0443067150.Google Scholar
- 20.Sasongko TH, Nagalla S, Ballas SK. Angiotension-converting enzyme (ACE) inhibitors for proteinuria and microalbuminuria in people with sickle cell disease. Cochrane Datab Syst Rev. 2013;3:009191.Google Scholar