Table II.
Summary of Studies of Albuminuria in Sickle Cell Disease
| Reference | Number of patients | Mean or median age/range | Type of study | Measurement | Prevalence | Comments |
|---|---|---|---|---|---|---|
| Alvarez et al. [46] | 120 | 4–20 years | Retrospective | Microalbuminuria | 15.8% | • Increased age associated with microalbuminuria. |
| • Early transfusion protective of microalbuminuria. | ||||||
| • Positive correlation with acute chest syndrome. | ||||||
| Dharnidharka et al. [47] | 102 | 2–18 years | Prospective | Microalbuminuria | 26.5% | • More common in patients older than 10years. |
| • Increasing age only variable associated with microalbuminuria. | ||||||
| McBurney et al. [49] | 142 | 21 months–20 years | Retrospective | Microalbuminuria | 19% | • Increased age and lower hemoglobin correlated with microalbuminuria. |
| McKie et al. [50] | 191 | 3–20 years | Prospective | Microalbuminuria | 19.4% | • Increased age and lower hemoglobin in patients with microalbuminuria. |
| • Four of nine patients receiving hydroxyurea demonstrated regression of microalbuminuria. | ||||||
| McPherson Yee et al. [51] | 410 | 2–21 years | Cross sectional | Microalbuminuria | 20.7% | • Increased age and lower hemoglobin in patients with microalbuminuria. |
| Aygun et al. [17] | 23 | 2.5–14 years | Prospective | Microalbuminuria | 17.4% | • All subjects treated with hydroxyrea. |
| • After 3 years of therapy, microalbuminuria resolved in two patients, persisted in two patients, and two patients developed new microalbuminuria. | ||||||
| • Treatment with hydroxyurea resulted in reduction in hyperfiltration, with associated decrease in LDH and increase in HbF levels. | ||||||
| Thompson et al. [15] | 65 | 18–23 years | Cross sectional | Albuminuria | 26.2% | • eGFR and SBP correlated positively with albumin excretion. |
| • Serum sodium and hematocrit correlated negatively with albumin excretion. | ||||||
| Bolarinwa et al. [61] | 68 | 15–60 years | Cross sectional | Albuminuria | 50.0% | • DBP associated with albuminuria. |
| • Albuminuria more common with worsening CKD stage. | ||||||
| Laurin et al. [54] | 149 | 18–71 years | Retrospective | Albuminuria | 45.0% | • Lower hemoglobin associated with albuminuria. |
| • Hydroxyurea use associated with a third lower likelihood of albuminuria. | ||||||
| Ataga et al. [25] | 73 | 39a years | Cross sectional | Albuminuria | 53.4% | • Weak correlation with age and albumin excretion. |
| • eGFR lowest in patients with macroalbuminuria. | ||||||
| • NT-proBNP, sFLT-1 higher in patients with macroalbuminuria. | ||||||
| • Higher TRV with macroalbuminuria. | ||||||
| • Association of urine albumin excretion with suspected pulmonary hypertension and history of stroke. | ||||||
| • Among HbSS and HbSβ0 patients, albuminuria associated with VCAM-1 and hypertension. | ||||||
| Guasch et al. [38] | 300 | 19–76 years | Cross sectional | Albuminuria | 58% | • Higher prevalence in HbSS (68%). |
| • Prevalence of albuminuria increased with age. | ||||||
| Iwalokun et al. [52] | 103 | 10.4b years | Cross sectional | Albuminuria | 22.3% | • Albuminuria associated with age, irreversibly sickled RBC, creatinine, packed cell volume and asymptomatic bacteruria. |
| • Irreversibly sickled RBC only independent predictor of albuminuria. | ||||||
| Asnani et al. [39] | 121 | 24.1–32.5 years | Cross sectional | Albuminuria | 33.6% | • Higher prevalence in HbSS. |
| • In HbSS, albuminuria associated with higher mean arterial pressure, higher WBC, lower hemoglobin, lower reticulocyte count, and lower serum creatinine. | ||||||
| • In HbSC, albuminuria associated with higher WBC and higher creatinine. | ||||||
| Wigfall et al. [48] | 442 | 2–21 years | Prospective | Proteinuria (urinalysis) | 4.5% | • Increased prevalence with age. |
| • Associated with stroke, acute chest syndrome, hospitalizations, and cholelithiasis. | ||||||
| Falk et al. [7] | 381 | N/A (children and adults) | Prospective | Proteinuria (urinalysis) | 26% | • In 10 patients treated with enalapril, mean reduction in proteinuria of 57% from baseline after 2 weeks. |
| Aleem [[53] | 67 | 23.8 ± 7.2 yearsb | Cross sectional | Proteinuria (24hr urine) | 40.3% | • Higher age in patients with proteinuria, but not statistically significant |
| De Castro et al. [59] | 75 | 39.3 ± 11.7 yearsb | Retrospective | Proteinuria (urinalysis) | 28% | • Proteinuria was associated with TRV ≥ 2.5 m/s. |
| • Proteinuria inversely correlated with eGFR in patients with TRV ≥ 2.5 m/s. | ||||||
| Elmariah et al. [62] | 542 | 18–84 years | Cross sectional | Proteinuria (urinalysis) | 26% | • Proteinuria and reduced renal function both associated with greater mortality. |
| Forrest et al. [60] | 85 | 6–21 years | Retrospective | Proteinuria (urinalysis) | N/A | • Elevated TRV ≥ 2.5 m/s is associated with proteinuria on longitudinal follow up. |
a
Median.
b
Mean.
CKD = Chronic kidney disease; eGFR = Estimated glomerular filtration rate; SBP = Systolic blood pressure; DBP = Diastolic blood pressure; TRV = Tricuspid regurgitant jet velocity; RBC = Red blood cells; WBC = White blood cells; HbF = Fetal hemoglobin; HTN = Hypertension; LDH = Lactate dehydrogenase; sFLT-1 = soluble fms-like tyrosine kinase-1; NT-proBNP = N-terminal pro-brain natriuretic peptide; VCAM-1 = Vascular cell adhesion molecule-1.