title: Chronic kidney disease and albuminuria in children with sickle cell disease.
abstract: OBJECTIVE
  Sickle cell nephropathy begins in childhood and may progress to renal failure. Albuminuria is a sensitive marker of glomerular damage that may indicate early chronic kidney disease (CKD).
  
  
  METHODS
  The aims of this study were to determine the cross-sectional prevalence and clinical correlates of albuminuria and CKD among children with sickle cell disease (SCD). Over a 10-year period (1995 to 2005) 410 pediatric SCD patients ages 2 to 21 years were enrolled: 261 with hemoglobin SS (HbSS) or HbSβ(0) thalassemia (HbSβ(0)) and 149 with HbSC or HbSβ(+) thalassemia (HbSβ(+)). The albumin/creatinine ratio (ACR) of spot-urine specimens and serum creatinine were measured; abnormal albuminuria was defined as urinary ACR ≥ 30 mg/g.
  
  
  RESULTS
  The prevalence of abnormal albuminuria was 20.7% (23.0% in HbSS/HbSβ(0), 16.8% in HbSC/HbSβ(+)). Among HbSS/HbSβ(0), abnormal albuminuria was associated with increasing age and lower baseline hemoglobin. GFR, estimated in 189 patients using the updated Schwartz formula, correlated negatively with age (r = -0.27, P = 0.0002). CKD defined according to the Kidney Disease: Improving Global Outcomes study was present in 26.5% (50 of 189) of patients: stage 1 in 27 (14.8%) and stage 2 in 22 (11.6%). In multivariate analysis, age and HbSC/HbSβ(+) genotype were associated with CKD.
  
  
  CONCLUSIONS
  This is the first study to stage CKD in children with SCD and highlights a high prevalence of albuminuria and glomerular injury early in life. Detecting CKD in childhood could allow for earlier intervention and prevention of renal failure in adulthood.
authors.affiliation: Department of Pediatrics, Division of Hematology/Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA. Marianne.McPherson@choa.org
authors.forename: Marianne
authors.initials: M
authors.lastname: McPherson Yee
authors.forename: Shameem F
authors.initials: SF
authors.lastname: Jabbar
authors.forename: Ifeyinwa
authors.initials: I
authors.lastname: Osunkwo
authors.forename: Lisa
authors.initials: L
authors.lastname: Clement
authors.forename: Peter A
authors.initials: PA
authors.lastname: Lane
authors.forename: James R
authors.initials: JR
authors.lastname: Eckman
authors.forename: Antonio
authors.initials: A
authors.lastname: Guasch
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000419:Albuminuria / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D000755:Anemia, Sickle Cell / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics; D015415:Biomarkers / Q000097:blood / Q000652:urine; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003404:Creatinine / Q000097:blood / Q000652:urine; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D005845:Georgia / Q000453:epidemiology; D005919:Glomerular Filtration Rate; D006451:Hemoglobin, Sickle / Q000235:genetics; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D051437:Renal Insufficiency / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D006451:Hemoglobin, Sickle; D003404:Creatinine