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Lactate dehydrogenase as a predictor of kidney involvement in patients with sickle cell anemia

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Abstract

A retrospective chart review of 40 patients with sickle cell anemia (SCA) between the ages of 5–19 years who were seen within a 1-year period was performed to determine clinical and laboratory correlates for microalbuminuria and proteinuria. Age, sex, height, body mass index (BMI), serum creatinine [and estimated glomerular filtration rate (eGFR) by Schwartz and MDRD formulas], type of SCA, hemoglobin (Hb) level [total Hb and hemoglobin F percentage (HbF%)], lactate dehydrogenase (LDH) level, reticulocyte count, blood pressure, history of splenectomy, history of hydroxyurea use, and history of transfusions were correlated with microalbuminuria and proteinuria by univariate and multivariate regression analysis. The prevalence of microalbuminuria and proteinuria among these patients was 15 and 5%, respectively. Univariate analyses revealed a significant correlation between LDH level and microalbuminuria (Pearson r = 0.47, p = 0.04) and between LDH level and proteinuria (Pearson r = 0.48, p=0.035). Multivariate analysis revealed a significant correlation between microalbuminuria and LDH level (p = 0.04) when controlled for age, sex, eGFR, Hb level, HbF%, type of SCA, BMI, history of transfusions, and reticulocyte count. In this pediatric SCA population, LDH was found to correlate with the presence of microalbuminuria and proteinuria. Further studies are needed to confirm LDH as an early marker for the risk of kidney involvement among SCA patients.

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References

  1. Guasch A, Navarrete J, Nass K, Zayas CF (2006) Glomerular involvement in adults with sickle cell hemoglobinopathies: prevalence and clinical correlates of progressive renal failure. J Am Soc Nephrol 17:2228–2235

    Article  CAS  PubMed  Google Scholar 

  2. Steinberg MH (1999) Management of sickle cell disease. N Engl J Med 340:1021–1030

    Article  CAS  PubMed  Google Scholar 

  3. Powars DR, Elliott-Mills DD, Chan L, Niland J, Hiti AL, Opas LM, Johnson C (1991) Chronic renal failure in sickle cell disease: risk factors, clinical course, and mortality. Ann Intern Med 115:614–620

    CAS  PubMed  Google Scholar 

  4. McBurney PG, Hanevold CD, Hernandez CM, Waller JL, McKie KM (2002) Risk factors for microalbuminuria in children with sickle cell anemia. J Pediatr Hematol Oncol 24:473–477

    Article  PubMed  Google Scholar 

  5. Marsenic O, Couloures KG, Wiley JM (2008) Proteinuria in children with sickle cell disease. Nephrol Dial Transplant 23:715–720

    Article  CAS  PubMed  Google Scholar 

  6. Tejani A, Phadke K, Adamson O, Nicastri A, Chen CK, Sen D (1985) Renal lesions in sickle cell nephropathy in children. Nephron 39:352–355

    Article  CAS  PubMed  Google Scholar 

  7. McKie KT, Hanevold CD, Hernandez C, Waller JL, Ortiz L, McKie KM (2007) Prevalence, prevention, and treatment of microalbuminuria and proteinuria in children with sickle cell disease. J Pediatr Hematol Oncol 29:140–144

    Article  CAS  PubMed  Google Scholar 

  8. Schmitt F, Martinez F, Brillet G, Giatras I, Choukroun G, Girot R, Bachir D, Galacteros F, Lacour B, Grunfeld JP (1998) Early glomerular dysfunction in patients with sickle cell anemia. Am J Kidney Dis 32:208–214

    Article  CAS  PubMed  Google Scholar 

  9. Datta V, Ayengar JR, Karpate S, Chaturvedi P (2003) Microalbuminuria as a predictor of early glomerular injury in children with sickle cell disease. Indian J Pediatr 70:307–309

    Article  PubMed  Google Scholar 

  10. Allon M (1990) Renal abnormalities in sickle cell disease. Arch Intern Med 150:501–504

    Article  CAS  PubMed  Google Scholar 

  11. Allon M, Lawson L, Eckman JR, Delaney V, Bourke E (1988) Effects of nonsteroidal antiinflammatory drugs on renal function in sickle cell anemia. Kidney Int 34:500–506

    Article  CAS  PubMed  Google Scholar 

  12. Brenner BM, Meyer TW, Hostetter TH (1982) Dietary protein intake and the progressive nature of kidney disease: the role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic renal disease. N Engl J Med 307:652–659

    Article  CAS  PubMed  Google Scholar 

  13. Etteldorf JN, Smith JD, Tuttle AH, Diggs LW (1955) Renal hemodynamic studies in adults with sickle cell anemia. Am J Med 18:243–248

    Article  CAS  PubMed  Google Scholar 

  14. Aoki RY, Saad ST (1990) Microalbuminuria in sickle cell disease. Braz J Med Biol Res 23:1103–1106

    CAS  PubMed  Google Scholar 

  15. Walker BR, Alexander F, Birdsall TR, Warren RL (1971) Glomerular lesions in sickle cell nephropathy. JAMA 215:437–440

    Article  CAS  PubMed  Google Scholar 

  16. Lonsdorfer A, Comoe L, Yapo AE, Lonsdorfer J (1989) Proteinuria in sickle cell trait and disease: an electrophoretic analysis. Clin Chim Acta 181:239–247

    Article  CAS  PubMed  Google Scholar 

  17. Dharnidharka VR, Dabbagh S, Atiyeh B, Simpson P, Sarnaik S (1998) Prevalence of microalbuminuria in children with sickle cell disease. Pediatr Nephrol 12:475–478

    Article  CAS  PubMed  Google Scholar 

  18. Falk RJ, Scheinman J, Phillips G, Orringer E, Johnson A, Jennette JC (1992) Prevalence and pathologic features of sickle cell nephropathy and response to inhibition of angiotensin-converting enzyme. N Engl J Med 326:910–915

    Article  CAS  PubMed  Google Scholar 

  19. Schrier RW, Gottschalk CW (1997) Diseases of the kidney. Little, Brown, Boston

    Google Scholar 

  20. Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263

    CAS  PubMed  Google Scholar 

  21. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in renal disease study group. Ann Intern Med 130:461–470

    CAS  PubMed  Google Scholar 

  22. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114:555–576

    Google Scholar 

  23. Wesson DE (2002) The initiation and progression of sickle cell nephropathy. Kidney Int 61:2277–2286

    Article  PubMed  Google Scholar 

  24. Fitzhugh CD, Wigfall DR, Ware RE (2005) Enalapril and hydroxyurea therapy for children with sickle nephropathy. Pediatr Blood Cancer 45:982–985

    Article  PubMed  Google Scholar 

  25. Foucan L, Bourhis V, Bangou J, Merault L, Etienne-Julan M, Salmi RL (1998) A randomized trial of captopril for microalbuminuria in normotensive adults with sickle cell anemia. Am J Med 104:339–342

    Article  CAS  PubMed  Google Scholar 

  26. Rother RP, Bell L, Hillmen P, Gladwin MT (2005) The clinical sequelae of intravascular hemolysis and extracellular plasma hemoglobin: a novel mechanism of human disease. JAMA 293:1653–1662

    Article  CAS  PubMed  Google Scholar 

  27. Kato GJ, McGowan V, Machado RF, Little JA, Jt T, Morris CR, Nichols JS, Wang X, Poljakovic M, Morris SM Jr, Gladwin MT (2006) Lactate dehydrogenase as a biomarker of hemolysis-associated nitric oxide resistance, priapism, leg ulceration, pulmonary hypertension, and death in patients with sickle cell disease. Blood 107:2279–2285

    Article  CAS  PubMed  Google Scholar 

  28. Taylor JG 6th, Nolan VG, Mendelsohn L, Kato GJ, Gladwin MT, Steinberg MH (2008) Chronic hyper-hemolysis in sickle cell anemia: association of vascular complications and mortality with less frequent vasoocclusive pain. PLoS ONE 3:e2095

    Article  PubMed  Google Scholar 

  29. Reiter CD, Wang X, Tanus-Santos JE, Hogg N, Cannon RO 3rd, Schechter AN, Gladwin MT (2002) Cell-free hemoglobin limits nitric oxide bioavailability in sickle-cell disease. Nat Med 8:1383–1389

    Article  CAS  PubMed  Google Scholar 

  30. Al-Salem AH (2006) Indications and complications of splenectomy for children with sickle cell disease. J Pediatr Surg 41:1909–1915

    Article  PubMed  Google Scholar 

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Correspondence to Sevgi Gurkan.

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Gurkan, S., Scarponi, K.J., Hotchkiss, H. et al. Lactate dehydrogenase as a predictor of kidney involvement in patients with sickle cell anemia. Pediatr Nephrol 25, 2123–2127 (2010). https://doi.org/10.1007/s00467-010-1560-8

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  • DOI: https://doi.org/10.1007/s00467-010-1560-8

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