title: Early blood transfusions protect against microalbuminuria in children with sickle cell disease.
abstract: BACKGROUND
  Microalbuminuria (MA) is an early indicator for glomerulopathy in sickle cell disease (SCD).
  
  
  METHODS
  We reviewed the medical records of asymptomatic patients ages 4-20 with sickle hemoglobinopathies, who were screened for MA in order to find out its prevalence and risk factors.
  
  
  RESULTS
  Nineteen of 120 (15.8%) screened patients had MA detected by spot urine (mean albumin absolute value 6.95 +/- 0.56 mg/dl) and abnormal albumin to creatinine ratios (79.8 +/- 0.62 mg/g creatinine). Twenty four-hour urine collections confirmed 57% of MA cases by spot urine. There was no difference in hyperfiltration between positive and negative patients. From the MA-positive patients, 15 had SS (16.8% of SS group) and 4 had SC (18% of SC group). Nineteen percent of children 10 years of age or older had MA, as compared to 8% of the younger children (P = 0.018), demonstrating that increasing age is a risk factor for MA. There was a positive correlation between MA and acute chest syndrome. Young age at start of chronic transfusions was inversely related to MA and therefore renoprotective (P = 0.03). We did not see a protective effect in the group of patients taking hydroxyurea for a relatively short time, mean age at start of treatment 12 +/- 5 years; however the sample was small.
  
  
  CONCLUSIONS
  We conclude that: (1) children with sickle cell hemoglobinopathies 10 years or older should be screened for MA and (2) chronic transfusions starting at an early age may be renoprotective.
authors.affiliation: Division of Pediatric Hematology, University of Miami, Holtz Children's Hospital, Miami, Florida 33136, USA. oalvarez@med.miami.edu
authors.forename: Ofelia
authors.initials: O
authors.lastname: Alvarez
authors.forename: Brenda
authors.initials: B
authors.lastname: Montane
authors.forename: Gabriela
authors.initials: G
authors.lastname: Lopez
authors.forename: James
authors.initials: J
authors.lastname: Wilkinson
authors.forename: Tracie
authors.initials: T
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D000419:Albuminuria / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D000704:Analysis of Variance; D000755:Anemia, Sickle Cell / Q000150:complications / Q000628:therapy*; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology