BACKGROUND: Proteinuria is a common manifestation of renal disease which is a significant cause of morbidity in patients with sickle cell disease (SCD). OBJECTIVE: To evaluate and compare cystatin C, beta(2)-microglobulin, and creatinine as markers of renal disease in relation to the degree of proteinuria and other complications of SCD. METHODS: 24 h urine collections were used for estimation of urine protein and creatinine clearance in 59 patients with SCD. Results were correlated with plasma cystatin C, beta(2)-microglobulin, creatinine, glomerular filtration rate (GFR; derived from plasma creatinine by Cockcroft-Gault, MDRD formulae, and calculated cystatin C clearance), and clinical and haematological variables. RESULTS: Comparing the different methods of GFR, the proportion of patients with hyperfiltration (GFR >140 ml/min) were 30.5% (MDRD), 44.1% (Cockcroft-Gault), and 10.2 % (calculated cystatin C clearance). Cystatin C was the most consistent marker of hyperfiltration. The endogenous markers of GFR showed an increasing trend with increasing proteinuria, but haematological variables were not correlated with cystatin C, beta(2)-microglobulin, or plasma creatinine. Urine protein excretion was correlated with age (r = 0.33) and significant proteinuria was present in 13.6% of patients. Patients with proteinuria had lower haemoglobin concentration (p = 0.027) than those without proteinuria but HbF was not related to the degree of proteinuria or to markers of GFR. CONCLUSIONS: Markers of GFR show variable ability to identify hyperfiltration in patients with SCD, but cystatin C is the best endogenous marker. Proteinuria is associated with age, haemoglobin, and abnormalities of GFR. Routine screening is recommended to allow for early detection and intervention.
BACKGROUND:Proteinuria is a common manifestation of renal disease which is a significant cause of morbidity in patients with sickle cell disease (SCD). OBJECTIVE: To evaluate and compare cystatin C, beta(2)-microglobulin, and creatinine as markers of renal disease in relation to the degree of proteinuria and other complications of SCD. METHODS: 24 h urine collections were used for estimation of urine protein and creatinine clearance in 59 patients with SCD. Results were correlated with plasma cystatin C, beta(2)-microglobulin, creatinine, glomerular filtration rate (GFR; derived from plasma creatinine by Cockcroft-Gault, MDRD formulae, and calculated cystatin C clearance), and clinical and haematological variables. RESULTS: Comparing the different methods of GFR, the proportion of patients with hyperfiltration (GFR >140 ml/min) were 30.5% (MDRD), 44.1% (Cockcroft-Gault), and 10.2 % (calculated cystatin C clearance). Cystatin C was the most consistent marker of hyperfiltration. The endogenous markers of GFR showed an increasing trend with increasing proteinuria, but haematological variables were not correlated with cystatin C, beta(2)-microglobulin, or plasma creatinine. Urine protein excretion was correlated with age (r = 0.33) and significant proteinuria was present in 13.6% of patients. Patients with proteinuria had lower haemoglobin concentration (p = 0.027) than those without proteinuria but HbF was not related to the degree of proteinuria or to markers of GFR. CONCLUSIONS: Markers of GFR show variable ability to identify hyperfiltration in patients with SCD, but cystatin C is the best endogenous marker. Proteinuria is associated with age, haemoglobin, and abnormalities of GFR. Routine screening is recommended to allow for early detection and intervention.
Authors: Edmund J Lamb; Joanna Wood; Helen J Stowe; Shelagh E O'Riordan; Michelle C Webb; R Neil Dalton Journal: Ann Clin Biochem Date: 2005-01 Impact factor: 2.057
Authors: Malgorzata Kasztan; Brandon M Fox; Jeffrey D Lebensburger; Kelly A Hyndman; Joshua S Speed; Jennifer S Pollock; David M Pollock Journal: Blood Adv Date: 2019-05-14
Authors: Ann T Farrell; Julie Panepinto; Ankit A Desai; Adetola A Kassim; Jeffrey Lebensburger; Mark C Walters; Daniel E Bauer; Rae M Blaylark; Donna M DiMichele; Mark T Gladwin; Nancy S Green; Kathryn Hassell; Gregory J Kato; Elizabeth S Klings; Donald B Kohn; Lakshmanan Krishnamurti; Jane Little; Julie Makani; Punam Malik; Patrick T McGann; Caterina Minniti; Claudia R Morris; Isaac Odame; Patricia Ann Oneal; Rosanna Setse; Poornima Sharma; Shalini Shenoy Journal: Blood Adv Date: 2019-12-10
Authors: Julia Z Xu; Melanie E Garrett; Karen L Soldano; Sean T Chen; Clary B Clish; Allison E Ashley-Koch; Marilyn J Telen Journal: Am J Hematol Date: 2018-09-27 Impact factor: 10.047
Authors: Magda O Seixas; Larissa C Rocha; Mauricio B Carvalho; Joelma F Menezes; Isa M Lyra; Valma M L Nascimento; Ricardo D Couto; Ájax M Atta; Mitermayer G Reis; Marilda S Goncalves Journal: Lipids Health Dis Date: 2010-08-27 Impact factor: 3.876