Microalbuminuria among Egyptian Children and Adult with Sickle Cell Hemoglobinopathy, Single Institution Study.

Introduction: Renal failure is one of the most serious complications of sickle cell diseases; it affects 5% – 18% and leads to early death. Protienuria is highly correlated with risk for future chronic renal failure.

Aim: to estimate the prevalence of microalbuminuria among Egyptian children and adults with sickle hemoglobinopathy, and to evaluate the effect ACE inhibitor on positive cases.

Subject and method: 60 patients (mean age 13.03±9.15) with sickle hemoglobinopathy were included. Patients were divided into 3 groups: sickle cell disease (group I) constituted 20%, Sickle ß-Thalassemia (group II) 46.6% and sickle cell trait (group III) 33.4%. Informed consent was obtained from patients and/or guardians and study approval by local IRB was obtained. Microalbuminuria was measured by turbidimetric assay in 24 hour urine collection. Patients with microalbuminuria were started on a 4 weeks trial of ACE inhibitor after excluding any contraindication for the drug. Patients were closely monitored for side effects and repeat microalbuminuria assay was done at the end of the trial period. Data were coded, entered and processed using SPSS (version 11).

Results: The prevalence of microalbuminuria was 32.5% in sickle cell disease, and sickle β thalassemia while in sickle cell trait was 5 % (p=0.02). The highest level of microalbuminuria (93.3+-146.27) was observed in sickle cell disease patients followed by sickle β thalassemia (63.82+-172.38) followed by sickle cell trait(18.75+-12.86).

Compared to patients with no microalbuminuria, the group with positive microalbuminuria was significantly older (18.31±4.48 vs. 9.24± 4.96 years), had higher number of blood transfusions / year (7.08±3.55 vs. 5.11±4.05), higher mean number of hemolytic crisis (2.38±1.98 vs. 1.11±1.19), higher mean number of pain crisis (2.92±1.61 vs. 2.2±1.48), and higher mean serum creatinine (0.63±0.31 vs. 0.47±0.19) (p<0.01).

After 4 weeks trial of ACE inhibitor there was a statistically significant reduction (77.9% reduction) in number of cases with microalbuminuria as well as level of microalbuminuria (dropped from 171.91 ± 251.60 to 27.11 ± 13.99) (p= 0.005). Conclusion: Microalbuminuria is a significant problem among patients with sickle cell disease. ACE inhibitors have significant impact on improving microalbuminuria.