Renal function in infants with sickle cell anemia: baseline data from the BABY HUG trial.
OBJECTIVE
To examine the feasibility and accuracy of glomerular filtration rate (GFR) measurements in infants with sickle cell anemia (SCA).


METHODS
The NHLBI/NICHD-sponsored Phase III randomized double-blinded placebo-controlled trial (BABY HUG) tests the hypothesis that hydroxyurea can prevent chronic organ damage in SCA. GFR elevation is a coprimary endpoint, measured quantitatively by technetium 99m-labeled diethylenetriaminepentaacetic acid (DTPA) plasma clearance and estimated by the Schwartz equation with height and creatinine.


RESULTS
Baseline DTPA GFR measurement was attempted in 191 infants; 176 of 184 completed studies (96%) were interpretable. Average age (mean +/- 1SD) was 13.7 +/- 2.6 months. Average DTPA GFR was 125.2 +/- 34.4 (range 40.2-300.9, normal 91.5 +/- 17.8 mL/min/1.73m(2)), while Schwartz estimates were higher at 184.4 +/- 55.5 mL/min/1.73m(2). DTPA GFR was correlated with Schwartz GFR (r(2) = 0.0658, P = .0012); also with age, weight, height, and kidney volume (all P < .002); but not with hemoglobin, HbF, white blood cell count, reticulocytes, medical events, or splenic function.


CONCLUSIONS
Quantitative GFR measurement is feasible but variable among infants with SCA. Schwartz GFR estimates are not highly correlated with quantitative DTPA GFR values. Baseline GFR measurements suggest that renal dysfunction in SCA, evidenced by glomerular hyperfiltration, begins during infancy.
Ware
Russell E
RE
St. Jude Children's Research Hospital, Memphis, TN 38105, USA. russell.ware@stjude.org
Rees
Renee C
RC
Sarnaik
Sharada A
SA
Iyer
Rathi V
RV
Alvarez
Ofelia A
OA
Casella
James F
JF
Shulkin
Barry L
BL
Shalaby-Rana
Eglal
E
Strife
C Frederic
CF
Miller
John H
JH
Lane
Peter A
PA
Wang
Winfred C
WC
Miller
Scott T
ST
D000755:Anemia, Sickle Cell / Q000503:physiopathology*; D003404:Creatinine / Q000097:blood; D005919:Glomerular Filtration Rate; D006801:Humans; D007223:Infant; D007668:Kidney / Q000503:physiopathology*; D004369:Pentetic Acid / Q000097:blood; D013154:Spleen / Q000503:physiopathology*
D004369:Pentetic Acid; D003404:Creatinine