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RENAL MANIFESTATIONS OF SICKLE CELL DISEASE
Jiyan Qasem*, Ibrahim Suliman and Firas Hussein
Background: Patients with sickle cell disease (SCD) are at increased risk of serious morbidity and mortality. Renal abnormalities in SCD are well known but renal involvement in Syrian patients with SCD has not been studied. Aim: We sought to identify the renal manifestations of sickle cell anemia among patients attending Tishreen University Hospital in Lattakia. Materials and Methods: This descriptive observational study included 76 patients (42 males, 34 females) diagnosed with sickle cell anemia confirmed by hemoglobin electrophoresis, and followed at Tishreen University Hospital in Lattakia, during the period between 2019 - 2020. The glomerular filtration rate was estimated (eGFR) using the ‘modification of diet in renal disease’ (MDRD) formula. All patients underwent evaluation by urine examination to detect hematuria, and 24- hour urine collection to measure to quantitate proteinuria. We constructed a multivariate logistic regression model to assess the association between hydroxyurea and proteinuria. Results: The renal manifestations of sickle cell anemia were as follows: glomerular hyperfiltration (9.2%), impaired renal function (31.6%), proteinuria (39.5%), and hematuria (19.7%). Patients with impaired renal function had a greater mean age and a higher prevalence of proteinuria compared with patients with normal renal function. A statistically significant inverse linear relationship was found between age and eGFR values (r = -0.547, p <0.001). The mean age of patients with proteinuria was greater compared to patients without proteinuria (P <0.05). Use of hydroxyurea is associated with a lower prevalence of proteinuria in patients with sickle cell anemia. The mean eGFR in patients treated with hydroxyurea was significantly greater compared to patients not treated with hydroxyurea (P <0.05). Conclusion: Renal abnormalities are present in a significant number of Syrian patients with SCD and proteinuria is the most common abnormality. Hydroxyurea use may prevent development of overt nephropathy or the progression of sickle cell disease nephropathy to end- stage renal disease.[Full Text Article]