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Bugeja A, Blanco P, Clark EG, Sood MM. Sickle cell disease: a case report of renal amyloidosis. BMC Nephrol 2018; 19:256. [PMID: 30305036 PMCID: PMC6180649 DOI: 10.1186/s12882-018-1047-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 09/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The development of proteinuria and reduced glomerular filtration rate is associated with higher mortality among patients with sickle cell disease (SCD). AA amyloidosis, also associated with increased mortality, in SCD is rare. We present a case of a woman with homozygous sickle cell disease with nephrotic syndrome and antibodies to double stranded DNA without clinical features of systemic lupus erythematosus. Kidney biopsy reveals AA amyloidosis and is the first report of concomitant AA amyloidosis with antibodies to double stranded DNA in SCD. CASE PRESENTATION A 40-year-old Central African woman with homozygous sickle cell disease and history of vaso-occlusive pain crises undergoes kidney biopsy for nephrotic-range proteinuria. Kidney biopsy reveals AA type amyloidosis, which is a rare manifestation of SCD in the kidney. Her anemia worsens with an ACE inhibitor, initiated to reduce proteinuria and limit GFR decline, so it was discontinued. Hydroxyurea, shown to decrease the frequency of vaso-occlusive crises and lower proteinuria, was subsequently initiated but then discontinued due to worsening anemia. Unfortunately, her glomerular filtration rate worsens. CONCLUSIONS AA amyloidosis and antibodies to double stranded DNA can occur in sickle cell disease. ACE inhibition and hydroxyurea decrease proteinuria so they may limit progression of chronic kidney disease. Hydroxyurea also decreases frequency of vaso-occlusive pain crises so it might be helpful in limiting progression of renal AA amyloidosis. However, further studies are needed to determine optimal treatment strategies for AA amyloidosis in sickle cell disease.
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Affiliation(s)
- Ann Bugeja
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Riverside Campus, 1967 Riverside Drive, Ottawa, ON, K1H 7W9, Canada.
| | - Paula Blanco
- Department of Pathology, The Ottawa Hospital and University of Ottawa, General Campus, 501 Smyth Road, Ottawa, ON, K1H 7W9, Canada
| | - Edward G Clark
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Riverside Campus, 1967 Riverside Drive, Ottawa, ON, K1H 7W9, Canada
| | - Manish M Sood
- Division of Nephrology, Department of Medicine, The Ottawa Hospital and University of Ottawa, Riverside Campus, 1967 Riverside Drive, Ottawa, ON, K1H 7W9, Canada
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52
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How I treat the older adult with sickle cell disease. Blood 2018; 132:1750-1760. [PMID: 30206116 DOI: 10.1182/blood-2018-03-818161] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/21/2018] [Indexed: 12/31/2022] Open
Abstract
With increasing survival, cumulative complications of sickle cell disease (SCD), which develop insidiously over time, are becoming more apparent and common in older patients, particularly those in their fifth decade and beyond. The older patient is also more likely to develop other age-related nonsickle conditions that interact and add to the disease morbidity. A common misconception is that any symptom in a SCD patient is attributable to their SCD and this may lead to delays in diagnosis and appropriate intervention. We recommend regular comprehensive reviews and monitoring for early signs of organ damage and a low threshold for the use of hydroxyurea and blood transfusions as preventative measures for end-organ disease. Treatable comorbidities and acute deterioration should be managed aggressively. Although the primary goal in management of the older adult with SCD is improving anemia and minimizing organ damage, the time has come for us to be more proactive in considering curative therapies previously offered to the younger patient. Curative or experimental interventions should be discussed early, before complications render the patients ineligible for these treatments.
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53
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Heimlich JB, Chipoka G, Elsherif L, David E, Ellis G, Kamthunzi P, Krysiak R, Mafunga P, Zhou Q, Cai J, Gopal S, Key NS, Ataga KI. Nephrin as a biomarker of sickle cell glomerulopathy in Malawi. Pediatr Blood Cancer 2018; 65:e26993. [PMID: 29411937 PMCID: PMC5911184 DOI: 10.1002/pbc.26993] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/03/2017] [Accepted: 12/22/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Glomerulopathy is an increasingly identified complication in young patients with sickle cell disease (SCD). Hyperfiltration and albuminuria followed by declining glomerular filtration rates and eventual end-stage renal disease (ESRD) is assumed to be the typical progression of glomerular disease. There are only a few reported biomarkers to identify early-stage renal disease in SCD. PROCEDURES We detail the renal profile of 101 children with SCD in Malawi and propose a novel urinary biomarker for the identification of early renal disease. RESULTS Among children with sickle cell anemia, 24.8% had a urine albumin-creatinine ratio of 30 mg/g or above. In univariate analysis, only patients with higher urinary nephrin, a urinary marker of glomerular injury, had significantly greater odds of having albuminuria. In multivariable analysis, nephrin remained significantly associated with albuminuria. A nephrin-creatinine ratio (NCR) cut-point of 622 ng/mg, the 50th percentile, was associated with a 45.8 times greater odds of having albuminuria in children with nephrinuria above this value. Further analysis revealed this urinary NCR cut-point to have 96% sensitivity, 64% specificity, 47% positive predictive value, and 98% negative predictive value for the presence of albuminuria. CONCLUSIONS These data suggest that a substantial number of children with SCD in Malawi have renal disease and could be at risk for worsening nephropathy and ESRD as they age. Our data suggest that urinary nephrin could be utilized as an early marker of glomerular disease in SCD.
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Affiliation(s)
- J. Brett Heimlich
- UNC Project-Malawi, Lilongwe, Malawi,Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Laila Elsherif
- University of North Carolina, Chapel Hill, North Carolina
| | - Emeraghi David
- University of North Carolina, Chapel Hill, North Carolina
| | - Graham Ellis
- UNC Project-Malawi, Lilongwe, Malawi,Naval Medical Center San Diego, San Diego, CA
| | | | | | | | - Qingning Zhou
- University of North Carolina, Charlotte, North Carolina
| | - Jianwen Cai
- University of North Carolina, Chapel Hill, North Carolina
| | - Satish Gopal
- UNC Project-Malawi, Lilongwe, Malawi,University of North Carolina, Chapel Hill, North Carolina
| | - Nigel S. Key
- University of North Carolina, Chapel Hill, North Carolina
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54
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Donnola SB, Piccone CM, Lu L, Batesole J, Little J, Dell KM, Flask CA. Diffusion tensor imaging MRI of sickle cell kidney disease: initial results and comparison with iron deposition. NMR IN BIOMEDICINE 2018; 31:10.1002/nbm.3883. [PMID: 29350437 PMCID: PMC5822685 DOI: 10.1002/nbm.3883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/19/2017] [Accepted: 11/14/2017] [Indexed: 06/07/2023]
Abstract
Chronic kidney disease (CKD) occurs in over one-third of patients with sickle cell disease (SCD) and can progress to end-stage renal disease. Unfortunately, current clinical assessments of kidney function are insensitive to early-stage CKD. Previous studies have shown that diffusion magnetic resonance imaging (MRI) can sensitively detect regional renal microstructural changes associated with early-stage CKD. However, previous MRI studies in patients with SCD have been largely limited to the detection of renal iron deposition assessed by T2 * relaxometry. In this pilot imaging study, we compare MRI assessments of renal microstructure (diffusion) and iron deposition (T2 *) in patients with SCD and in non-SCD control subjects. Diffusion tensor imaging (DTI) and T2 * relaxometry MRI data were obtained for pediatric (n = 5) and adult (n = 4) patients with SCD, as well as for non-SCD control subjects (n = 10), on a Siemens Espree 1.5-T MRI scanner. A region-of-interest analysis was used to calculate mean medullary and cortical values for each MRI metric. MRI findings were also compared with clinical assessments of renal function and hemolysis. Patients with SCD showed a significant decrease in medullary fractional anisotropy (FA, p = 0.0001) in comparison with non-SCD subjects, indicative of microstructural alterations in the renal medulla of patients with SCD. Cortical and medullary reductions in T2 * (increased iron deposition, p = ≤0.0001) were also observed. Significant correlations were also observed between kidney T2 * assessments and multiple measures of hemolysis. This is the first DTI MRI study of patients with SCD to demonstrate reductions in medullary FA despite no overt CKD [estimated glomerular filtration rate (eGFR) > 100 mL/min/1.73 m2 ]. These medullary FA changes are consistent with previous studies in patients with CKD, and suggest that DTI MRI can provide a useful measure of kidney injury to complement MRI assessments of iron deposition.
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Affiliation(s)
- Shannon B. Donnola
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Connie M. Piccone
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
- Divison of Hematology/Oncology, Rainbow Babies and Children’s Hospital, Cleveland, Ohio, USA
| | - Lan Lu
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Joshua Batesole
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jane Little
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Division of Hematology and Oncology, University Hospitals - Cleveland Medical Center, Cleveland, Ohio, USA
| | - Katherine M. Dell
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
- Center for Pediatric Nephrology, Cleveland Clinic Children’s, Cleveland, Ohio, USA
- CWRU Center for Kidney Research, The MetroHealth System, Cleveland, Ohio, USA
| | - Chris A. Flask
- Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
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55
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Prevalence of Microalbuminuria in Adult Patients with Sickle Cell Disease in Eastern Saudi Arabia. Int J Nephrol 2018; 2018:5015764. [PMID: 29682347 PMCID: PMC5848055 DOI: 10.1155/2018/5015764] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/08/2018] [Accepted: 02/01/2018] [Indexed: 11/17/2022] Open
Abstract
Background Proteinuria is a common feature of sickle cell nephropathy (SCN) that can progress to renal insufficiency and end stage renal disease. Microalbuminuria (MA) is the earliest manifestation of SCN and precedes the development of overt proteinuria. In addition to the renal consequences, MA is linked to cardiovascular complications. Periodic screening and early detection of MA allow early intervention that may reduce the risk of progression to advanced renal failure and cardiovascular diseases. Objective The aim of this study was to investigate the prevalence of MA in patients with SCD in the eastern region of Saudi Arabia. Methods A prospective cross-sectional observational study was conducted at Johns Hopkins Aramco Healthcare (JHAH). Urine samples of SCD patients 18 years old and older were tested for the presence of MA using urinary albumin over creatinine ratio (ACR). Correlation was tested with multiple variables including age, gender, body mass index (BMI), hemoglobin level, blood pressure, blood transfusion history, pain episodes, and use of hydroxyurea. Results Urine samples were tested on 72 patients. The mean age of the study cohort was 35 ± 16.9 years. Microalbuminuria was detected in 18 patients (25%). No correlation was found with any of the tested variables. Conclusion Microalbuminuria is a common finding in patients with SCD in eastern Saudi Arabia. Patients with SCD should be screened for MA, and those with positive tests should probably be treated with antiproteinuric agents that may slow the progression to advanced stages of renal failure and decrease the risk of cardiovascular diseases.
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56
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Jerebtsova M, Saraf SL, Lin X, Lee G, Adjei EA, Kumari N, Afangbedji N, Raslan R, McLean C, Gordeuk VR, Nekhai S. Identification of ceruloplasmin as a biomarker of chronic kidney disease in urine of sickle cell disease patients by proteomic analysis. Am J Hematol 2018; 93:E45-E47. [PMID: 29127684 DOI: 10.1002/ajh.24965] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/06/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Marina Jerebtsova
- Department of Microbiology; Howard University; Washington District Columbia
| | - Santosh L. Saraf
- Section of Hematology-Oncology, Department of Medicine; University of Illinois at Chicago; Chicago Illinois
| | - Xionghao Lin
- Center for Sickle Cell Disease, Howard University; Washington District Columbia
| | - Gillian Lee
- Center for Sickle Cell Disease, Howard University; Washington District Columbia
| | - Elena Afia Adjei
- Center for Sickle Cell Disease, Howard University; Washington District Columbia
- Department of Human Genetics; Howard University; Washington District Columbia
| | - Namita Kumari
- Center for Sickle Cell Disease, Howard University; Washington District Columbia
| | - Nowah Afangbedji
- Center for Sickle Cell Disease, Howard University; Washington District Columbia
| | - Rasha Raslan
- Section of Hematology-Oncology, Department of Medicine; University of Illinois at Chicago; Chicago Illinois
| | - Charlee McLean
- Center for Sickle Cell Disease, Howard University; Washington District Columbia
| | - Victor R. Gordeuk
- Section of Hematology-Oncology, Department of Medicine; University of Illinois at Chicago; Chicago Illinois
| | - Sergei Nekhai
- Department of Microbiology; Howard University; Washington District Columbia
- Center for Sickle Cell Disease, Howard University; Washington District Columbia
- Department of Medicine, College of Medicine; Howard University; Washington District Columbia
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57
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Hariri E, Mansour A, El Alam A, Daaboul Y, Korjian S, Aoun Bahous S. Sickle cell nephropathy: an update on pathophysiology, diagnosis, and treatment. Int Urol Nephrol 2018; 50:1075-1083. [PMID: 29383580 DOI: 10.1007/s11255-018-1803-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 01/21/2018] [Indexed: 12/13/2022]
Abstract
Sickle cell nephropathy is a major complication of sickle cell disease. It manifests in different forms, including glomerulopathy, proteinuria, hematuria, and tubular defects, and frequently results in end-stage renal disease (ESRD). Different pathophysiologic mechanisms have been proposed to explain the development of nephropathy in SCD, where hemolysis and vascular occlusion are the main contributors in the manifestations of this disease. Markers of renal injury, such as proteinuria and tubular dysfunction, have been associated with outcomes among patients with sickle cell nephropathy and provide means for early detection of nephropathy and screening prior to progression to renal failure. In small-sized clinical trials, hydroxyurea has demonstrated to be effective in slowing the progression to ESRD. Dialysis and renal transplantation represent the last resort for patients with sickle cell nephropathy. Nevertheless, despite the availability of diagnostic and therapeutic strategies, sickle cell nephropathy remains a challenging and under-recognized complication for patients with sickle cell disease.
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Affiliation(s)
- Essa Hariri
- Cardiovascular Medicine, Department of Internal Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Anthony Mansour
- Lebanese American University School of Medicine, Byblos, Lebanon
| | - Andrew El Alam
- Lebanese American University School of Medicine, Byblos, Lebanon
| | - Yazan Daaboul
- Department of Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Serge Korjian
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sola Aoun Bahous
- Lebanese American University School of Medicine, Byblos, Lebanon. .,Division of Nephrology and Transplantation, Department of Medicine, Lebanese American University Medical Center - Rizk Hospital, May Zahhar Street, P.O. Box 11-3288, Ashrafieh, Beirut, Lebanon.
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58
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Vichinsky E. Chronic organ failure in adult sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:435-439. [PMID: 29222290 PMCID: PMC6142529 DOI: 10.1182/asheducation-2017.1.435] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Sickle cell disease is now a chronic adult illness characterized by progressive multiorgan failure, particularly involving the brain and kidney. The etiology is multifactorial; it includes hemolysis and nitric oxide deficiency. As patients age, most experience neurologic insult. Twenty-five percent of older adults have had a clinical stroke and at least half of the population have had a silent infarct, cortical atrophy, and neurocognitive impairment. Periodic screening with neuroimaging and neurocognitive testing is recommended. Identification and correction of modifiable risk factors such as nocturnal hypoxemia, obstructive sleep apnea, and physical exercise programs should be implemented. Patients with neurocognitive impairment require cognitive remediation and educational accommodations. Chronic renal disease occurs in 25% of older adults and results in 50% of their deaths. Renal failure often develops insidiously. It can be prevented or minimized by early screening and treatment of modifiable risk factors including hypertension and microalbuminuria. There is an increasing number of therapeutic options, including inhibitors of the renin angiotensin system, angiotensin-II receptor blockers, endothelin-1 receptor antagonist, and haptoglobin therapy. Patients with sickle cell disease have increased mortality rates from renal failure compared with nonsickle cell patients, in part from a lack of access to early multidisciplinary care, including timely initiation of dialysis and renal transplantation.
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MESH Headings
- Adult
- Albuminuria/diagnosis
- Albuminuria/etiology
- Albuminuria/metabolism
- Albuminuria/therapy
- Anemia, Sickle Cell/complications
- Anemia, Sickle Cell/diagnosis
- Anemia, Sickle Cell/drug therapy
- Anemia, Sickle Cell/metabolism
- Angiotensin Receptor Antagonists/therapeutic use
- Haptoglobins/therapeutic use
- Humans
- Hypertension/diagnosis
- Hypertension/drug therapy
- Hypertension/etiology
- Hypertension/metabolism
- Multiple Organ Failure/diagnosis
- Multiple Organ Failure/drug therapy
- Multiple Organ Failure/etiology
- Multiple Organ Failure/metabolism
- Renal Insufficiency, Chronic/diagnosis
- Renal Insufficiency, Chronic/drug therapy
- Renal Insufficiency, Chronic/etiology
- Renal Insufficiency, Chronic/metabolism
- Renin-Angiotensin System
- Risk Factors
- Sleep Apnea, Obstructive/diagnosis
- Sleep Apnea, Obstructive/drug therapy
- Sleep Apnea, Obstructive/etiology
- Sleep Apnea, Obstructive/metabolism
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59
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Naik RP, Derebail VK. The spectrum of sickle hemoglobin-related nephropathy: from sickle cell disease to sickle trait. Expert Rev Hematol 2017; 10:1087-1094. [PMID: 29048948 DOI: 10.1080/17474086.2017.1395279] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Renal dysfunction is among the most common complication of sickle cell disease (SCD), from hyposthenuria in children to progression to overt chronic kidney disease (CKD) in young adults. Emerging evidence now suggests that sickle hemoglobin-related nephropathy extends to individuals with sickle cell trait (SCT). Areas covered: This review will highlight the pathophysiology, epidemiology, and management recommendations for sickle hemoglobin-related nephropathy in both SCD and SCT. In addition, it will focus on the major demographic and genetic modifiers of renal disease in sickling hemoglobinopathies. Expert commentary: Studies have elucidated the course of renal disease in SCD; however, the scope and age of onset of renal dysfunction in SCT has yet to be determined. In SCD, several modifiers of renal disease - such as α-thalassemia, hemoglobin F, APOL1 and HMOX1 - have been described and provide an opportunity for a precision medicine approach to risk stratify patients who may benefit from early intervention. Extrapolating from this literature may also provide insight into the modifiers of renal disease in SCT. Further studies are needed to determine the optimal treatment for sickle hemoglobin-related nephropathy.
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Affiliation(s)
- Rakhi P Naik
- a Division of Hematology, Department of Medicine , Johns Hopkins University , Baltimore , MD , USA
| | - Vimal K Derebail
- b Division of Nephrology and Hypertension, Department of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
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60
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Legrand T, Rakotoson MG, Galactéros F, Bartolucci P, Hulin A. Determination of hydroxyurea in human plasma by HPLC-UV using derivatization with xanthydrol. J Chromatogr B Analyt Technol Biomed Life Sci 2017; 1064:85-91. [DOI: 10.1016/j.jchromb.2017.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/19/2017] [Accepted: 09/06/2017] [Indexed: 11/30/2022]
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Yee ME, Lane PA, Archer DR, Joiner CH, Eckman JR, Guasch A. Losartan therapy decreases albuminuria with stable glomerular filtration and permselectivity in sickle cell anemia. Blood Cells Mol Dis 2017; 69:65-70. [PMID: 28951038 DOI: 10.1016/j.bcmd.2017.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 09/20/2017] [Indexed: 01/06/2023]
Abstract
Sickle cell nephropathy begins with hyperfiltration and microalbuminuria and may progress to renal failure. The aim of this study was to determine the effects of losartan on glomerular function and albumin excretion in sickle cell anemia (SCA). Individuals with SCA on hydroxyurea with persistent albuminuria were enrolled in a 1-year study of losartan. Glomerular filtration rate (GFR) measured by iohexol clearance, albumin excretion rate (AER), and fractional clearance of dextran were assessed at baseline, short-term (1-2month), and long-term (≥12month) intervals. Twelve subjects (6 microalbuminuria, 6 macroalbuminuria) completed short-term studies; 8 completed long-term studies. Baseline GFR was 112ml/min/1.73m2 (71-147ml/min/1.73m2). AER decreased significantly at the short-term (median decrease -134 mcg/min, p=0.0063). GFR was not significantly-different at short-term or long-term intervals. Dextran clearance improved for diameters smaller than albumin (<36Å) but not larger sizes. Losartan therapy for ≥1year in sickle nephropathy results in lower albumin excretion with stable GFR. Filtration of neutral molecules ≥36Å was not changed by losartan, suggesting that the effect of losartan is a mechanism other than alteration of glomerular filtration size-selectivity.
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Affiliation(s)
- Marianne E Yee
- Department of Pediatrics, Hematology/Oncology, Emory University, Atlanta, GA, United States; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, United States.
| | - Peter A Lane
- Department of Pediatrics, Hematology/Oncology, Emory University, Atlanta, GA, United States; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - David R Archer
- Department of Pediatrics, Hematology/Oncology, Emory University, Atlanta, GA, United States; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Clinton H Joiner
- Department of Pediatrics, Hematology/Oncology, Emory University, Atlanta, GA, United States; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - James R Eckman
- Emory University, Department of Medicine, Hematology/Oncology, Atlanta, GA, United States
| | - Antonio Guasch
- Department of Medicine, Renal Division, Emory University, Atlanta, GA, United States
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62
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Ware RE, de Montalembert M, Tshilolo L, Abboud MR. Sickle cell disease. Lancet 2017; 390:311-323. [PMID: 28159390 DOI: 10.1016/s0140-6736(17)30193-9] [Citation(s) in RCA: 550] [Impact Index Per Article: 78.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/11/2016] [Accepted: 11/18/2016] [Indexed: 01/08/2023]
Abstract
Sickle cell disease is a common and life-threatening haematological disorder that affects millions of people worldwide. Abnormal sickle-shaped erythrocytes disrupt blood flow in small vessels, and this vaso-occlusion leads to distal tissue ischaemia and inflammation, with symptoms defining the acute painful sickle-cell crisis. Repeated sickling and ongoing haemolytic anaemia, even when subclinical, lead to parenchymal injury and chronic organ damage, causing substantial morbidity and early mortality. Currently available treatments are limited to transfusions and hydroxycarbamide, although stem cell transplantation might be a potentially curative therapy. Several new therapeutic options are in development, including gene therapy and gene editing. Recent advances include systematic universal screening for stroke risk, improved management of iron overload using oral chelators and non-invasive MRI measurements, and point-of-care diagnostic devices. Controversies include the role of haemolysis in sickle cell disease pathophysiology, optimal management of pregnancy, and strategies to prevent cerebrovascular disease.
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Affiliation(s)
- Russell E Ware
- Division of Hematology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | | | - Léon Tshilolo
- Centre Hospitalier Monkole, Kinshasa, Democratic Republic of Congo
| | - Miguel R Abboud
- Department of Pediatrics, American University of Beirut, Beirut, Lebanon
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63
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Kormann R, Jannot AS, Narjoz C, Ribeil JA, Manceau S, Delville M, Joste V, Prié D, Pouchot J, Thervet E, Courbebaisse M, Arlet JB. Roles of APOL1 G1 and G2 variants in sickle cell disease patients: kidney is the main target. Br J Haematol 2017; 179:323-335. [PMID: 28699644 DOI: 10.1111/bjh.14842] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/28/2017] [Indexed: 12/29/2022]
Abstract
In African-American patients with sickle cell disease (SCD), APOL1 G1 and G2 variants are associated with increased risk of sickle cell nephropathy (SCN). To determine the role of APOL1 variants in SCD patients living in Europe, we genotyped 152 SCD patients [aged 30·4 (24·3-36·4) years], mainly of Sub-Saharan African ancestry, for APOL1 G1 and G2 and for variants of four genes with kidney tropism (GSTM1, GSTT1, GSTP1, and HMOX1). Homozygous or double-heterozygous APOL G1 and G2 genotypes were strongly associated with end stage renal disease (P = 0·003) and worse Kidney Disease: Improving Global Outcomes stages (P = 0·001). Further, these genotypes were associated in an age-dependent manner with lower estimated glomerular filtration rate (eGFR, P = 0·008), proteinuria (P = 0·009) and albuminuria (P < 0·001) but not with other SCD complications. Compared to APOL1 G1/wild type (WT), the APOL1 G2/WT genotype was associated with a lower eGFR (P = 0·04) in an age-dependent manner, suggesting that the G2/WT patients are likely to have worse kidney prognosis. Other genes variants analysed were not associated with SCN or other SCD complications. Our data indicate that APOL1 screening should be considered for the management of SCD patients, including those of non-African-American origin, as those with homozygous or double heterozygous variants are clearly at higher risk of SCN.
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Affiliation(s)
- Raphaël Kormann
- Physiology Department, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes Faculty of Medicine, Paris, France
| | - Anne-Sophie Jannot
- Paris Descartes Faculty of Medicine, Paris, France.,INSERM UMR 1138-E22: Information Sciences & Personalized Medicine, Paris, France.,Medical Informatics, Biostatistics and Public Health Department, Georges Pompidou University Hospital, Paris, France
| | - Céline Narjoz
- Paris Descartes Faculty of Medicine, Paris, France.,Biochemistry Department, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Institut National pour la Santé et la Recherche Médicale (INSERM) UMR-S 1147, Paris, France
| | - Jean-Antoine Ribeil
- Paris Descartes Faculty of Medicine, Paris, France.,Biotherapy Department, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Biotherapy Clinical Investigation Centre, Groupe Hospitalier Universitaire Ouest, Assistance Publique-Hôpitaux de Paris, INSERM, Paris, France.,Centre de Référence des Syndromes Drépanocytaires Majeurs, Necker-Enfants-Malades University Hospital, APHP, Université Paris 5, Paris, France
| | - Sandra Manceau
- Paris Descartes Faculty of Medicine, Paris, France.,Biotherapy Department, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marianne Delville
- Paris Descartes Faculty of Medicine, Paris, France.,Biotherapy Department, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Centre de Référence des Syndromes Drépanocytaires Majeurs, Necker-Enfants-Malades University Hospital, APHP, Université Paris 5, Paris, France
| | - Valentin Joste
- Paris Descartes Faculty of Medicine, Paris, France.,Biochemistry Department, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Dominique Prié
- Paris Descartes Faculty of Medicine, Paris, France.,INSERM U1151-CNRS UMR8253, Paris, France.,AP-HP, Necker Children's Hospital, Physiology Department, Paris Descartes University, Paris, France
| | - Jacques Pouchot
- Paris Descartes Faculty of Medicine, Paris, France.,Internal Medicine Department, Sickle Cell Referral Centre, Faculté de Médecine Paris Descartes, Sorbonne Paris-Cité et Assistance Publique-Hôpitaux de Paris, Georges Pompidou University Hospital, Paris, France
| | - Eric Thervet
- Paris Descartes Faculty of Medicine, Paris, France.,Institut National pour la Santé et la Recherche Médicale (INSERM) UMR-S 1147, Paris, France.,Department of Nephrology, Georges Pompidou University Hospital, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - Marie Courbebaisse
- Physiology Department, Georges Pompidou European Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Paris Descartes Faculty of Medicine, Paris, France.,INSERM U1151-CNRS UMR8253, Paris, France
| | - Jean-Benoît Arlet
- Paris Descartes Faculty of Medicine, Paris, France.,Internal Medicine Department, Sickle Cell Referral Centre, Faculté de Médecine Paris Descartes, Sorbonne Paris-Cité et Assistance Publique-Hôpitaux de Paris, Georges Pompidou University Hospital, Paris, France.,Laboratory of Excellence GR-Ex, Paris, France
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64
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Audard V, Bartolucci P, Stehlé T. Sickle cell disease and albuminuria: recent advances in our understanding of sickle cell nephropathy. Clin Kidney J 2017; 10:475-478. [PMID: 28852484 PMCID: PMC5570022 DOI: 10.1093/ckj/sfx027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 02/17/2017] [Indexed: 12/16/2022] Open
Abstract
Albuminuria is considered to be a relevant biomarker for the detection of early glomerular damage in patients with sickle cell disease (SCD). Improvements in our understanding of the pathophysiological processes and molecular mechanisms underlying albuminuria are required, because increasing numbers of patients with SCD are developing chronic kidney disease. The early recognition of sickle cell nephropathy (SCN) and studies of the natural course of this emerging renal disease are therefore crucial, together with identification of the associated clinical and biological risk factors, to make it possible to initiate kidney-protective therapy at early stages of renal impairment. The pathophysiological process underlying SCN remains hypothetical, but chronic haemolysis-related endothelial dysfunction and the relative renal hypoxia triggered by repeated vaso-occlusive crises have been identified as two potential key factors. The optimal preventive and curative management of albuminuria in the context of SCD is yet to be established, but recent studies have suggested that hydroxyurea therapy, the cornerstone of SCD treatment, could play a key role in reducing albuminuria. The place of conventional kidney-protecting measures, such as renin–angiotensin system inhibitors, in the treatment of SCD patients also remains to be determined.
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Affiliation(s)
- Vincent Audard
- Service de Néphrologie et Transplantation, Institut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris-Est Créteil (UPEC), Créteil, France.,Unité INSERM U955, Equipe 21, Centre de Référence Syndrome Néphrotique Idiopathique, UPEC, Créteil, France
| | - Pablo Bartolucci
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Groupe Hospitalier Henri Mondor-Albert Chenevier, APHP, UPEC, Créteil, France.,Service de Médecine Interne, Groupe Hospitalier Henri Mondor-Albert Chenevier, APHP, UPEC, Créteil, France.,Unité INSERM 955, Equipe 2 émergente, UPEC, Créteil, France.,Laboratoire of Excellence GR-Ex, Paris, France
| | - Thomas Stehlé
- Service de Néphrologie et Transplantation, Institut Francilien de Recherche en Néphrologie et Transplantation (IFRNT), Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris-Est Créteil (UPEC), Créteil, France.,Unité INSERM U955, Equipe 21, Centre de Référence Syndrome Néphrotique Idiopathique, UPEC, Créteil, France
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65
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Chaturvedi S, Labib Ghafuri D, Kassim A, Rodeghier M, DeBaun MR. Elevated tricuspid regurgitant jet velocity, reduced forced expiratory volume in 1 second, and mortality in adults with sickle cell disease. Am J Hematol 2017; 92:125-130. [PMID: 27806442 DOI: 10.1002/ajh.24598] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 10/28/2016] [Accepted: 10/31/2016] [Indexed: 12/23/2022]
Abstract
Cardiopulmonary disease is the leading cause of mortality in adults with sickle cell disease (SCD). Elevated tricuspid regurgitant jet velocity (TRJV) and reduced forced expiratory volume in 1 second (FEV1 ) %predicted are associated with early mortality in SCD; however their relationship and combined effect on survival is unknown. We investigated the relationship between TRJV and FEV1 %predicted, and their combined effect on mortality, in a retrospective cohort of 189 adults with SCD who underwent both pulmonary function testing and echocardiography. Nineteen (9.9%) of 189 patients died over a median follow-up of 1.4 years; cardiopulmonary disease was the major cause of death in 52.6%. FEV1 %predicted was negatively associated with TRJV (Spearman rho, -0.34, P < 0.001). Individuals with FEV1 %predicted ≤70% were more likely to have an elevated TRJV ≥2.5 m/second, compared to those with FEV1 %predicted >70% [45.8% versus 17.1%; odds ratio (OR) 4.1 (95% Confidence interval ([CI] 2.1-8.0); P = 0.001]. In a multivariable cox regression model, the combination of TRJV ≥2.5 m/second and FEV1 %predicted ≤70% predicted earlier mortality [hazard ratio (HR) 4.97 (95% CI 1.30-18.91; P = 0.019)] after adjusting for age, sex, and nephropathy. Both FEV1 %predicted ≤70% and TRJV ≥2.5 m/second were independently associated with nephropathy [OR 4.48 (95% CI 1.51-13.31); P = 0.004] and [OR 3.27 (95% CI 1.19-9.00); P = 0.017], respectively. In conclusion, pulmonary and cardiac impairment are associated with, and contribute to mortality in SCD. Therapies aimed at improving reduced FEV1 %predicted and elevated TRJV could improve survival in patients with SCD. Am. J. Hematol. 92:125-130, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Shruti Chaturvedi
- Division of Hematology and Oncology, Department of Medicine; Vanderbilt University; Nashville, Tennessee
| | | | - Adetola Kassim
- Division of Hematology and Oncology, Department of Medicine; Vanderbilt University; Nashville, Tennessee
- Vanderbilt-Meharry Sickle Cell Disease Center of Excellence; Nashville, Tennessee
| | | | - Michael R. DeBaun
- Department of Pediatrics; Vanderbilt University Medical Center; Nashville, Tennessee
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66
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Pecker LH, Schaefer BA, Luchtman-Jones L. Knowledge insufficient: the management of haemoglobin SC disease. Br J Haematol 2016; 176:515-526. [PMID: 27982424 DOI: 10.1111/bjh.14444] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Although haemoglobin SC (HbSC) accounts for 30% of sickle cell disease (SCD) in the United States and United Kingdom, evidence-based guidelines for genotype specific management are lacking. The unique pathology of HbSC disease is complex, characterized by erythrocyte dehydration, intracellular sickling and increased blood viscosity. The evaluation and treatment of patients with HbSC is largely inferred from studies of SCD consisting mostly of haemoglobin SS (HbSS) patients. These studies are underpowered to allow definitive conclusions about HbSC. We review the pathophysiology of HbSC disease, including known and potential differences between HbSS and HbSC, and highlight knowledge gaps in HbSC disease management. Clinical and translational research is needed to develop targeted treatments and to validate management recommendations for efficacy, safety and impact on quality of life for people with HbSC.
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Affiliation(s)
- Lydia H Pecker
- Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC, USA.,Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Beverly A Schaefer
- Cancer and Blood Diseases Institute, Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lori Luchtman-Jones
- Cancer and Blood Diseases Institute, Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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