Shatat Ibrahim F, Qanungo Suparna, Hudson Shannon, Laken Marilyn A, Hailpern Susan M
Pediatric Nephrology and Hypertension, Sidra Medical and Research Center, Doha, Qatar; College of Nursing, Medical University of South Carolina, Charleston, SC, USA; Weill Cornell Medical College, New York, NY, USA.
College of Nursing, Medical University of South Carolina , Charleston, SC , USA.
Front Pediatr. 2016 Oct 7;4:106. doi: 10.3389/fped.2016.00106. eCollection 2016.
Approximately 20% of children with sickle cell disease (SCD) have microalbuminuria (MA). Very little is known about the progression of MA in children and young adults with SCD.
In this study, we analyzed 5-year EMR data of 373 children [with ≥2 microalbumin-to-creatinine (MA/Cr) ratio measurements] followed at the Medical University of South Carolina to determine the rate, direction, magnitude, and predictors of MA/Cr change over time.
Age range was 1-22 years; mean 10.2 ± 5.2 years, 49.5% were males. Median follow-up duration was 3.12 ± 1.16 years. At baseline, 328 children had normal (<20 mg/L) MA level. Forty-five (12.1%) of children had MA (≥20 mg/L), of which 91% were ≥8 years and 21 (47%) continued to have MA at the end of the study period. On the other hand, during the study period, 24 new patients developed MA and 24 normalized their MA to levels <20 mg/L. In multivariate logistic regression model, age and bilirubin levels were predictive of MA/Cr increase in patients who received at least one blood transfusion during the study period. Baseline MA level was not predictive of the change in MA/Cr.
In children and young adults, microalbuminuria is considered a marker of early renal injury. Over time, MA/Cr levels may increase or decrease. Further studies are needed to confirm our findings, assess the reliability of MA as marker of long-term renal injury, and identify high risk patients with SCD likely to have worsening of MA over time.
约20%的镰状细胞病（SCD）患儿存在微量白蛋白尿（MA）。对于患有SCD的儿童和青年中MA的进展情况，人们了解甚少。
在本研究中，我们分析了南卡罗来纳医科大学随访的373名儿童（有≥2次微量白蛋白与肌酐（MA/Cr）比值测量结果）的5年电子病历数据，以确定MA/Cr随时间变化的速率、方向、幅度及预测因素。
年龄范围为1至22岁；平均年龄10.2±5.2岁，49.5%为男性。中位随访时间为3.12±1.16年。基线时，328名儿童的MA水平正常（<20mg/L）。45名（12.1%）儿童存在MA（≥20mg/L），其中91%年龄≥8岁，21名（47%）在研究期末仍有MA。另一方面，在研究期间，24名新患者出现MA，24名患者的MA恢复至<20mg/L的正常水平。在多因素逻辑回归模型中，年龄和胆红素水平可预测研究期间至少接受过一次输血的患者MA/Cr升高。基线MA水平不能预测MA/Cr的变化。
在儿童和青年中，微量白蛋白尿被视为早期肾损伤的标志物。随着时间推移，MA/Cr水平可能升高或降低。需要进一步研究来证实我们的发现，评估MA作为长期肾损伤标志物的可靠性，并识别SCD中MA可能随时间恶化的高危患者。
