Dharnidharka V R, Dabbagh S, Atiyeh B, Simpson P, Sarnaik S
Department of Pediatrics, Children's Hospital of Michigan and Wayne State University, Detroit 48201, USA.
Pediatr Nephrol. 1998 Aug;12(6):475-8. doi: 10.1007/s004670050491.
Renal involvement is common in homozygous sickle cell disease (HbSS), including glomerular hypertension and hypertrophy similar to that seen in rodent models of ablative nephrectomy and stage I diabetic nephropathy (DN). The proteinuria in the rodent models is attenuated by angiotensin converting enzyme inhibition (ACEI). Microalbuminuria (MA) is a sensitive marker for renal involvement in DN prior to the development of proteinuria, and is also attenuated with ACEI. Elevated urinary microalbumin/creatinine ratios (U Alb/Cr) >20 mg/g Cr are reported in 39%-43% of adults with HbSS, and studies are ongoing in this age group to assess the effect of attenuated proteinuria by ACEI on long-term renal function. The purpose of this study was to prospectively investigate the prevalence of MA in children with HbSS and determine factors which affect its expression. U Alb/Cr values were measured on spot urine samples in 102 children (aged 2-18 years, mean 9.47+/-4.62, M:F=53:49) by rate nephelometry. Children with prior known proteinuria, hypertension, or fever/pain episode in the last 15 days were excluded. MA was present in 26.5% of all children with HbSS. However, in children between the ages of 10 and 18 years, the prevalence was 46% (similar to the prevalence in adults). There was a strong correlation between patient age and prevalence of MA (P<0.0001) by both univariate and multivariate analysis. However, pain frequency, hospitalization, transfusion program, ferritin levels, and Cr clearance (C(Cr)) did not correlate with prevalence, although C(Cr) (as estimated by Schwartz formula) was elevated in all. We conclude that the prevalence of MA in the 2nd decade of life is similar to that in adults.
纯合子镰状细胞病（HbSS）常伴有肾脏受累，包括肾小球高血压和肥大，类似于在切除性肾切除术和I期糖尿病肾病（DN）的啮齿动物模型中所见。啮齿动物模型中的蛋白尿可通过血管紧张素转换酶抑制（ACEI）得以减轻。微量白蛋白尿（MA）是DN在出现蛋白尿之前肾脏受累的敏感标志物，也可通过ACEI减轻。据报道，39% - 43%的成年HbSS患者尿微量白蛋白/肌酐比值（U Alb/Cr）>20 mg/g Cr，目前该年龄组正在进行研究，以评估ACEI减轻蛋白尿对长期肾功能的影响。本研究的目的是前瞻性调查HbSS患儿中MA的患病率，并确定影响其表达的因素。通过速率散射比浊法对102名儿童（年龄2 - 18岁，平均9.47±4.62，男:女 = 53:49）的随机尿样进行U Alb/Cr值测量。排除既往有蛋白尿、高血压或过去15天内有发热/疼痛发作的儿童。所有HbSS患儿中有26.5%存在MA。然而，在10至18岁的儿童中，患病率为46%（与成人患病率相似）。单因素和多因素分析均显示，患者年龄与MA患病率之间存在强相关性（P<0.0001）。然而，疼痛频率、住院情况、输血方案、铁蛋白水平和肌酐清除率（C(Cr)）与患病率无关，尽管所有患儿的C(Cr)（根据施瓦茨公式估算）均升高。我们得出结论，MA在生命第二个十年的患病率与成人相似。
