Department of Pediatrics, ISN-Sister Renal Center, All India Institute of Medical Sciences (AIIMS), Madhya Pradesh, Bhopal, India.
Department of Pediatrics, Government Medical College, Vidisha, Madhya Pradesh, India.
Indian J Pediatr. 2021 Jun;88(6):562-567. doi: 10.1007/s12098-020-03558-8. Epub 2020 Nov 11.
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.
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.
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.
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.
评估镰状细胞病（SCD）患儿的血压研究较少，结果不一致。少数研究显示 SCD 患者诊室血压较低，而其他研究则显示存在隐匿性高血压和异常动态血压监测（ABPM）。因此，本研究旨在检测 SCD 患儿的 24 小时 ABPM 参数和肾功能，并与健康对照组进行比较。
进行了一项横断面研究，纳入了 56 名儿童（30 名 SCD 患儿和 26 名对照者）。进行 ABPM 检查和肾功能评估，包括血清肌酐、血清尿素、尿肌酐、尿蛋白和比重。
与对照组（p<0.001）相比，SCD 患儿的点尿蛋白/肌酐比值更高（63.3%）。不到 10 岁的 SCD 患儿中有 1/4 出现蛋白尿。隐匿性高血压患者 2 例（6.6%），动态高血压患者 4 例（13.3%），动态高血压前期患者 1 例（3.3%），异常夜间血压下降 60%。BMI 年龄 Z 评分与 24 小时收缩压 SDS（r=0.56，p=0.002）、估计肾小球滤过率（eGFR）与 24 小时舒张压 SDS（r=-0.52；p=0.038）呈显著正相关，eGFR 与年龄（r=0.54；p=0.025）呈显著正相关。
本研究证实，ABPM 异常（动态高血压、非杓型、动态高血压前期）和早期蛋白尿是 SCD 患者的重要发现。这强调了在常规护理中定期筛查蛋白尿和 ABPM 的重要性，以便早期发现和预防 SCD 患者的进行性肾损害。
