title: Renal dysfunction in patients with thalassaemia.
abstract: Little is known about the effects of thalassaemia on the kidney. Characterization of underlying renal function abnormalities in thalassaemia is timely because the newer iron chelator, deferasirox, can be nephrotoxic. We aimed to determine the prevalence and correlates of renal abnormalities in thalassaemia patients, treated before deferasirox was widely available, using 24-h collections of urine. We calculated creatinine clearance and urine calcium-to-creatinine ratio and measured urinary β(2) -microglobulin, albumin, and protein. We used multivariate modelling to identify clinical, therapeutic, and laboratory predictors of renal dysfunction. One-third of thalassaemia patients who were not regularly transfused had abnormally high creatinine clearance. Regular transfusions were associated with a decrease in clearance (P = 0·004). Almost one-third of patients with thalassaemia had hypercalciuria, and regular transfusions were associated with an increase in the frequency and degree of hypercalciuria (P < 0·0001). Albuminuria was found in over half of patients, but was not consistently associated with transfusion therapy. In summary, renal hyperfiltration, hypercalciuria, and albuminuria are common in thalassaemia. Higher transfusion intensity is associated with lower creatinine clearance but more frequent hypercalciuria. The transfusion effect needs to be better understood. Awareness of underlying renal dysfunction in thalassaemia can inform decisions now about the use and monitoring of iron chelation.
authors.affiliation: U.T. Southwestern Medical Center, Dallas, TX, USA. charles.quinn@cchmc.org
authors.forename: Charles T
authors.initials: CT
authors.lastname: Quinn
authors.forename: Valerie L
authors.initials: VL
authors.lastname: Johnson
authors.forename: Hae-Young
authors.initials: HY
authors.lastname: Kim
authors.forename: Felicia
authors.initials: F
authors.lastname: Trachtenberg
authors.forename: Maria G
authors.initials: MG
authors.lastname: Vogiatzi
authors.forename: Janet L
authors.initials: JL
authors.lastname: Kwiatkowski
authors.forename: Ellis J
authors.initials: EJ
authors.lastname: Neufeld
authors.forename: Ellen
authors.initials: E
authors.lastname: Fung
authors.forename: Nancy
authors.initials: N
authors.lastname: Oliveri
authors.forename: Melanie
authors.initials: M
authors.lastname: Kirby
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Giardina
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000209:etiology; D001806:Blood Urea Nitrogen; D002118:Calcium / Q000652:urine; D002648:Child; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D053565:Hypercalciuria / Q000209:etiology; D007674:Kidney Diseases / Q000097:blood / Q000209:etiology* / Q000652:urine; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000209:etiology; D013789:Thalassemia / Q000097:blood / Q000150:complications* / Q000628:therapy / Q000652:urine; D065227:Transfusion Reaction; D055815:Young Adult; D001613:beta 2-Microglobulin / Q000652:urine
chemical_list: D001613:beta 2-Microglobulin; D003404:Creatinine; D002118:Calcium