Skip to main content
SpringerLink
Log in

Proteinuria in adults with sickle-cell disease: the role of hydroxycarbamide(hydroxyurea) as a protective agent

  • Research Article
  • Published:
International Journal of Clinical Pharmacy Aims and scope Submit manuscript

Abstract

Background Renal abnormalities are often seen in sickle cell disease (SCD). Objective To investigate the role of hydroxycarbamide as a protective agent in sickle cell nephropathy. Setting Patients with SCD followed at a Hematology outpatients clinic. Methods Prospective study with 26 SCD patients. Renal function evaluation was performed and a comparison between patients and control group was done. Patients using hydroxycarbamide were compared to those not taking this drug. Main outcome measure Effect of hydroxycarbamide on renal function. Results Patients mean age was 32.1 ± 9.9 years, and 16 (61 %) were males. Glomerular hyperfiltration was found in nine patients with SCD (34.6 %). GFR < 60 mL/min/1.73 m2 was observed in three cases (11.5 %). Microalbuminuria (30–300 mg/day) was found in seven cases (27 %) and macroalbuminuria (>300 mg/dia) in one patient (3.8 %). All patients had urinary concentrating deficit, and inability to acidify urine was found in ten cases (38.4 %). The comparison of patients according to the use of hydroxycarbamide showed lower levels of serum creatinine in those using the drug (0.6 ± 0.1 vs. 0.8 ± 0.3 mg/dL, p = 0.03), as well as lower levels of 24 h-proteinuria (226 ± 16 vs. 414 ± 76 mg/dL, p = 0.0001), but not microalbuminuria (79 ± 15 vs. 55 ± 86 mg/dL, p = 0.35). Conclusion SCD is associated with important renal abnormalities. Hydroxycarbamide seems to protect kidney function in SCD by decreasing proteinuria but not microalbuminuria.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Loureiro MM, Rozenfeld S. Epidemiology of sickle cell disease hospital admissions in Brazil. Rev Saúde Pública. 2005;39(6):943–9.

    Article  PubMed  Google Scholar 

  2. Josephs H. Clinical aspects of sickle cell anemia. Bull Johns Hopkins Hosp. 1928;43:397–8.

    Google Scholar 

  3. Keitel HG, Thompson D, Itano HA. Hyposthenuria in sickle cell anemia: a reversible renal defect. J Clin Invest. 1956;35(9):998–1007.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Crosley AP, Strickland WH. Renal function in sickle cell anemia—a case report and review of the literature. J Natl Med Assoc. 1961;53(1):39–40.

    PubMed Central  PubMed  Google Scholar 

  5. Tsaras G, Owusu-Ansah A, Boateng FO, Amoateng-Adjepong Y. Complications associated with sickle cell trait: a brief narrative review. Am J Med. 2009;122(6):507–12.

    Article  PubMed  Google Scholar 

  6. Abo-Zenah H, Moharram M, El Nahas AM. Cardiorenal risk prevalence in sickle cell hemoglobinopathy. Nephron Clin Pract. 2009;112(2):c98–106.

    Article  CAS  PubMed  Google Scholar 

  7. Da Silva GB Jr, Libório AB, Daher Ede F. New insights on pathophysiology, clinical manifestations, diagnosis, and treatment of sickle cell nephropathy. Ann Hematol. 2011;90(12):1371–9.

    Article  PubMed  Google Scholar 

  8. Wang WC. Sickle cell anemia and other sickling syndromes. In: Greer JP, Foerster J, Rodgers GM, Paraskevas F, Glader B, Arber DA, Means Jr RT. Wintrobe’s clinical hematology, 12th edition. Philadelphia: Lippincott Williams and Wilkins, p. 1038–1082, 2009. ISBN: 978-0-7817-6507-7

  9. Saunthararajah Y, Vichinsky EP. Sickle cell disease—clinical features and management. In: Hoffman—Hematology: basic principles and practice. Oxford: Churchill Livingstone, 5th edn, p. 577–601, 2008. ISBN: 978-0443067150.

  10. Rees DC, Williams TN, Gladwin MT. Sickle-cell disease. Lancet. 2010;376(9757):2018–31.

    Article  CAS  PubMed  Google Scholar 

  11. Brandow AM, Panepinto JA. Hydroxycarbamide use in sickle cell disease: the battle with low prescription rates, poor patient compliance and fears of toxicities. Expert Rev Hematol. 2010;3(3):255–60.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Ware RE. How I use Hydroxycarbamide to treat young patients with sickle cell anemia. Blood. 2010;115(26):5300–11.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Brawley OW, Cornelius LJ, Edwards LR, Northington Gamble V, Green BL, Inturrisi C, et al. National institutes of health consensus development conference statement: hydroxycarbamide treatment for sickle cell disease. Ann Intern Med. 2008;148(12):932–8.

    Article  PubMed  Google Scholar 

  14. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF III, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Lobo C. Sickle cell disease—a serious problem for public health worldwide. Rev Bras Hematol Hemoter. 2010;32(4):280–1.

    Article  Google Scholar 

  16. Bartolucci P, Galactéros F. Clinical management of adult sickle-cell disease. Curr Opin Hematol. 2012;19(3):149–55.

    Article  PubMed  Google Scholar 

  17. Aygun B, Mortier NA, Smeltzer MP, Shulkin BL, Hankins JS, Ware RE. Hydroxycarbamide treatment decreases glomerular hyperfiltration in children with sickle cell anemia. Am J Hematol. 2013;88(2):116–9.

    Article  CAS  PubMed  Google Scholar 

  18. Alvarez O, Lopez-Mitnik G, Zilleruelo G. Short-term follow-up of patients with sickle cell disease and albuminuria. Pediatr Blood Cancer. 2008;50(6):1236–9.

    Article  PubMed  Google Scholar 

  19. Fitzhugh CD, Wigfall DR, Ware RE. Enalapril and hydroxycarbamide therapy for children with sickle nephropathy. Pediatr Blood Cancer. 2005;45(7):982–5.

    Article  PubMed  Google Scholar 

  20. Sasongko TH, Nagalla S, Ballas SK. Angiotension-converting enzyme (ACE) inhibitors for proteinuria and microalbuminuria in people with sickle cell disease. Cochrane Datab Syst Rev. 2013;3:009191.

    Google Scholar 

  21. Aleem A. Proteinuria in adult Saudi patients with sickle cell disease is not associated with identifiable risk factors. Saudi J Kidney Dis Transpl. 2010;21(5):903–8.

    PubMed  Google Scholar 

  22. Silva Junior GB, Vieira AP, Couto Bem AX, Alves MP, Meneses GC, Martins AM, et al. Renal tubular dysfunction in sickle cell disease. Kidney Blood Press Res. 2013;38(1):1–10.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We are very grateful to the team of physicians, residents, medical students, and nurses from the Walter Cantídio University Hospital, Federal University of Ceará, for providing technical support for the development of this research and for the exceptional assistance provided to the patients.

Funding

Prof. E.F.D., A.M.C.M. and A.B.L. received a grant from the Brazilian Research Council (Conselho Nacional de Desenvolvimento Científico e Tecnológico—CNPq, bolsa de produtividade em pesquisa).

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, School of Medicine, Federal University of Ceará, Rua Vicente Linhares, 1198, Fortaleza, Ceará, CEP 60135-270, Brazil

    Geraldo B. Silva Junior, Ana Patrícia F. Vieira, Amanda X. Couto Bem, Marília P. Alves, Alexandre V. Libório & Elizabeth F. Daher

  2. Health Sciences Center, School of Medicine and Master in Collective Health, University of Fortaleza, Fortaleza, Ceará, Brazil

    Geraldo B. Silva Junior & Sonia M. H. A. Araújo

  3. Department of Clinical and Toxicological Analysis, School of Pharmacy, Federal University of Ceará, Fortaleza, Ceará, Brazil

    Gdayllon C. Meneses & Alice M. C. Martins

Authors
  1. Geraldo B. Silva Junior
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ana Patrícia F. Vieira
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amanda X. Couto Bem
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marília P. Alves
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gdayllon C. Meneses
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alice M. C. Martins
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sonia M. H. A. Araújo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alexandre V. Libório
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Elizabeth F. Daher
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Geraldo B. Silva Junior.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Silva Junior, G.B., Vieira, A.P.F., Couto Bem, A.X. et al. Proteinuria in adults with sickle-cell disease: the role of hydroxycarbamide(hydroxyurea) as a protective agent. Int J Clin Pharm 36, 766–770 (2014). https://doi.org/10.1007/s11096-014-9955-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-014-9955-4

Keywords

Search

Navigation