Hyperuricemia is associated with a lower glomerular filtration rate in pediatric sickle cell disease patients

Autor: Wally R. Smith, Isidora R. Beach, India Sisler, Jennifer Newlin, Cristin D. W. Kaspar, Daniel I. Feig
Rok vydání: 2020
Předmět:
Male
Nephrology
congenital
hereditary
and neonatal diseases and abnormalities

medicine.medical_specialty
Adolescent
Population
030232 urology & nephrology
Renal function
Anemia
Sickle Cell

Hyperuricemia
030204 cardiovascular system & hematology
urologic and male genital diseases
Sickle cell nephropathy
Gastroenterology
Gout Suppressants
Cohort Studies
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Risk Factors
Internal medicine
Prevalence
Albuminuria
Humans
Medicine
Blood Transfusion
Child
education
Prospective cohort study
education.field_of_study
business.industry
medicine.disease
Uric Acid
Renal Elimination
Cross-Sectional Studies
chemistry
Pediatrics
Perinatology and Child Health

Uric acid
Female
Kidney Diseases
medicine.symptom
business
Glomerular Filtration Rate
Zdroj: Pediatric Nephrology. 35:883-889
ISSN: 1432-198X
0931-041X
DOI: 10.1007/s00467-019-04432-2
Popis: Sickle cell nephropathy (SCN) is a progressive disease that contributes significant morbidity and mortality in sickle cell disease (SCD), yet it remains poorly understood. Hyperuricemia negatively impacts renal function in the non-sickle cell population but is understudied in SCD. We performed a cross-sectional analysis of the first 78 pediatric SCD patients enrolled in a cohort study. The mechanism of development of hyperuricemia (defined, serum uric acid (UA) ≥ 5.5 mg/dL) was characterized as a result of either UA overproduction or inefficient renal excretion by the Simkin index and fractional clearance of urate (FCU) equations. Associations between hyperuricemia and albuminuria or estimated glomerular filtration rate (eGFR) were determined by linear regression. The prevalence of hyperuricemia in this young population (mean age 11.6 ± 3.77 years) was 34.2%. Only 1 hyperuricemic participant overproduced UA by Simkin index, while 62.5% were inefficient renal excretors of UA (FCU < 4%). Hyperuricemia was associated with a significant decrease in average eGFR, −27 ml/min/1.73m2 below normouricemia (mean eGFR 151.6 ± 40.32), p = 0.0122. Notably, the previously accepted association between decline of eGFR with age is significantly modified by hyperuricemia stratification, where hyperuricemia explains 44% of the variance in eGFR by age (R2 = 0.44, p = 0.0004) and is nonsignificant in normouricemia (R2 = 0.07, p = 0.0775). These findings indicate that hyperuricemia may be associated with early eGFR decline in SCN. This association must be further characterized in prospective cohort studies in SCN, and hyperuricemia must be investigated as a potential therapeutic target for SCN.
Databáze: OpenAIRE
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