Table III.
Evaluation and Treatment of Albuminuria in Sickle Cell Disease
| • Screening for albuminuria by standard dipstick urinalysis (with serum creatinine) at least yearly. |
| • Albuminuria detected by dipstick urinalysis should be quantified by 24-hr urine collection (or spot urine for protein-to-creatinine ratioa). |
| • In patients with overt proteinuria, HIV, RPR, hepatitis B, hepatitis C, complements, and antinuclear antibodies should be measured and urine sediment evaluated, particularly for presence of RBC casts, as they may suggest other diagnoses. Serum protein electrophoresis and/or serum free light chains should also be measured in older patients. Consider a renal biopsy if acute onset of nephrotic range proteinuria. |
| • Avoid use of NSAIDs. |
| • Adequate immunization—pneumococcal and influenza. |
| • Consider use of ACE inhibitors or ARBs, if there are no contraindications. Provide counseling regarding dietary potassium intake and monitor potassium following initiation. |
| • Consider use of hydroxyurea, especially in patients with history of frequent pain episodes, acute chest syndrome, or marked anemia. |
a
This method has not been validated in SCD.
HIV = Human immunodeficiency virus; RPR = Rapid plasma reagin; NSAIDs = Nonsteroidal anti-inflammatory drugs; ACE inhibitors = angiotensin converting enzyme inhibitors; ARBs = Angiotensin receptor blockers.