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Abnormal Ambulatory Blood Pressure and Early Renal Dysfunction in Sickle Cell Disease

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Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Objectives

There is sparsity of studies evaluating blood pressure in children with sickle cell disease (SCD), which have shown inconsistent results. Few of the studies have documented lower office blood pressure (BP) in SCD patients, whereas, others have shown presence of masked hypertension and abnormal ambulatory blood BP monitoring (ABPM). Thus, the present study was conducted to examine 24 h ABPM parameters and renal dysfunction in children with SCD and compare them with healthy controls.

Methods

A cross-sectional study was conducted on 56 children (30 children having SCD and 26 controls). ABPM and evaluation of renal functions including serum creatinine, serum urea, urinary creatinine, urinary protein and specific gravity was performed.

Results

Spot urinary protein to creatinine ratio was found to be higher in patients with SCD (63.3%) as compared to controls (p < 0.001). Proteinuria was observed in 1/4th of the SCD patients less than ten years of age. Masked hypertension was present in 2 (6.6%) patients, ambulatory hypertension in 4 (13.3%), ambulatory pre-hypertension in 1 (3.3%) and abnormal dipping in 60%. A statistically significant correlation of BMI for age Z-score and standard deviation score (SDS/Z) of 24 h systolic BP (r = 0.56, p = 0.002); estimated glomerular filtration rate (eGFR) with 24 h diastolic BP SDS (r = −0.52; p = 0.038) and age with e GFR (r = 0.54; p = 0.025) was found in the present study.

Conclusions

The present study corroborates that ABPM abnormalities (ambulatory hypertension, non-dipping pattern, ambulatory prehypertension) and early onset proteinuria are significant findings in patients with SCD. This underscores the importance of regular screening for proteinuria and ABPM in routine care, for early detection and prevention of progressive renal damage in SCD.

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Author information

Author notes

  1. Shiv Ram Krishna Dubey

    Present address: Department of Pediatrics, Government Medical College, Vidisha, Madhya Pradesh, India

  2. Neha Shrivastava

    Present address: Department of Pediatrics, Gandhi Medical College, Bhopal, Madhya Pradesh, India

Authors and Affiliations

  1. Department of Pediatrics, ISN-Sister Renal Center, All India Institute of Medical Sciences (AIIMS), Madhya Pradesh, Bhopal, India

    Shiv Ram Krishna Dubey, Neha Shrivastava, Girish C Bhatt & Bhavna Dhingra

  2. Department of Pathology & Lab Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India

    Tanya Sharma & Deepti Joshi

  3. Department of Community & Family Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India

    Abhijit P Pakhare

  4. Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India

    SK Goel

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  1. Shiv Ram Krishna Dubey
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Contributions

GCB conceptualized and wrote manuscript; SRKD, NS, BD, TS, DJ and SKG helped in carrying out the research work and reviewed manuscript for critical inputs. APP and GCB developed protocol and carried out statistical analysis. All authors read and approved the final version of the manuscript. GCB will act as guarantor for this paper.

Corresponding author

Correspondence to Girish C Bhatt.

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None.

Ethical Clearance

All procedures followed were in accordance with the ethical standards of the Instituttional Human ethics committee. The study was approved by Institutional human ethical committee (ref no. LOP/2015/IM0065).

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Dubey, S.R.K., Shrivastava, N., Sharma, T. et al. Abnormal Ambulatory Blood Pressure and Early Renal Dysfunction in Sickle Cell Disease. Indian J Pediatr 88, 562–567 (2021). https://doi.org/10.1007/s12098-020-03558-8

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  • DOI: https://doi.org/10.1007/s12098-020-03558-8

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