Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Int Urol Nephrol. 2023 Jul;55(7):1779-1785. doi: 10.1007/s11255-023-03506-3. Epub 2023 Feb 7.
Chronic anemia, iron overload, and iron chelation therapy are the main contributing factors for renal complications in thalassemia, e.g., nephrolithiasis, glomerular disease, and renal tubular dysfunction. The prevalence and associated factors for developing renal dysfunctions in Thai patients with thalassemia, however, remained limited. This study aimed to determine the prevalence and risk factors of renal dysfunctions in patients with thalassemia.
A cross-sectional study was conducted on adult patients with thalassemia disease at Srinagarind Hospital, Khon Kaen University, Thailand. All patients were evaluated for complete blood count, blood chemistry, urinalysis, and urine biochemistry. Renal tubular dysfunction was defined as existing in at least one of the following parameters including; proteinuria, hypercalciuria, hypouricemia with uricosuria, or hypophosphatemia with phosphaturia. Logistic regression analysis was used to identify associated factors for renal dysfunctions.
Of 105 patients, renal tubular dysfunction was found in 60 patients (57.1%). In multivariate analysis of the clinical risk factors for renal tubular dysfunction in thalassemia patients, age per 10 year increase (adjusted odds ratio [AOR] = 1.4, 95% CI: 1.0-2.0, p value 0.01) and Hb E/beta-thalassemia (AOR = 3.6, 95% CI: 1.3-10.3, p value 0.01) were statistically proven to be associated with renal tubular dysfunction. Hyperuricosuria was a significantly associated factor for microhematuria. (AOR = 2.9, 95% CI: 1.1-8.0, p value 0.03).
Renal dysfunctions are prevalent in thalassemia patients, with older age and Hb E/beta-thalassemia genotype as significant risk factors for renal tubular dysfunction. Hyperuricosuria is a risk factor for microhematuria. Renal dysfunctions should be recognized and monitored in aging patients with Hb E/beta-thalassemia.
慢性贫血、铁过载和铁螯合治疗是导致地中海贫血患者发生肾脏并发症的主要因素，例如肾结石、肾小球疾病和肾小管功能障碍。然而，泰国地中海贫血患者发生肾脏功能障碍的流行情况及其相关因素仍十分有限。本研究旨在确定泰国地中海贫血患者肾脏功能障碍的流行情况和危险因素。
本研究采用病例对照研究方法，对泰国孔敬大学诗琳通医院的地中海贫血成年患者进行研究。所有患者均接受了全血细胞计数、血液化学、尿液分析和尿液生化检查。肾小管功能障碍定义为至少存在以下一个参数异常：蛋白尿、高钙尿症、尿酸排泄增多伴低尿酸血症或磷排泄增多伴低磷血症。采用 logistic 回归分析确定与肾小管功能障碍相关的因素。
在 105 例患者中，有 60 例（57.1%）存在肾小管功能障碍。在多变量分析中，年龄每增加 10 岁（调整后的优势比 [AOR] = 1.4，95%可信区间：1.0-2.0，p 值 0.01）和 Hb E/β-地中海贫血（AOR = 3.6，95%可信区间：1.3-10.3，p 值 0.01）与肾小管功能障碍呈统计学相关。高尿酸尿症与镜下血尿显著相关（AOR = 2.9，95%可信区间：1.1-8.0，p 值 0.03）。
肾脏功能障碍在地中海贫血患者中较为常见，年龄较大和 Hb E/β-地中海贫血基因型是肾小管功能障碍的重要危险因素。高尿酸尿症是镜下血尿的危险因素。应在 Hb E/β-地中海贫血的老年患者中识别和监测肾脏功能障碍。
