Guasch A et al. (2006) Glomerular involvement in adults with sickle cell hemoglobinopathies: prevalence and clinical correlates of progressive renal failure. J Am Soc Nephrol 17: 2228–2235

A recent study has shown that the prevalence of glomerular damage in adults with various forms of sickle cell anemia is much higher than previously thought.

Guasch and colleagues investigated the prevalence of glomerular damage and clinical correlates of renal failure in 300 adults with the homozygously inherited, clinically severe hemoglobin SS disease (n = 184) and other sickling hemoglobinopathies (a total of 116 patients with the heterozygously inherited, generally less-severe SC or SD disease, or Sβ thalassemia of variable severity). The albumin excretion rate of patients with SS disease was more likely to be increased than that of patients with SC disease, SD disease, or Sβ thalassemia (68% vs 32%). Albuminuria tended to be associated with age and serum creatinine level in SS disease, and with age in other sickling disorders. There was no association between albuminuria and blood pressure in any patient group, and significant hypertension did not affect the 21% of patients with SS disease and renal insufficiency. Given this lack of association, the authors question the use of antihypertensive therapy per se in sufferers of sickle cell anemia, and suggest that targeting proteinuria, for example, might be more effective.

No differences in hematological parameters—including hemoglobin level—between patients with normal and abnormal albumin levels were detected. This finding implies that the mechanisms underlying development of glomerular damage in sickling hemoglobinopathies might not be solely related to chronic anemia.