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Hydroxyurea treatment decreases glomerular hyperfiltration in children with sickle cell anemia
Author(s) -
Aygun Banu,
Mortier Nicole A.,
Smeltzer Matthew P.,
Shulkin Barry L.,
Hankins Jane S.,
Ware Russell E.
Publication year - 2013
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.23365
Subject(s) - medicine , renal function , proteinuria , microalbuminuria , glomerular hyperfiltration , sickle cell anemia , urology , nephropathy , gastroenterology , endocrinology , kidney , diabetic nephropathy , diabetes mellitus , disease
Glomerular hyperfiltration and microalbuminuria/proteinuria are early manifestations of sickle nephropathy. The effects of hydroxyurea therapy on these renal manifestations of sickle cell anemia (SCA) are not well defined. Our objective was to investigate the effects of hydroxyurea on glomerular filtration rate (GFR) measured by 99m Tc‐DTPA clearance, and on microalbuminuria/proteinuria in children with SCA. Hydroxyurea study of long‐term effects (HUSTLE) is a prospective study (NCT00305175) with the goal of describing the long‐term cellular, molecular, and clinical effects of hydroxyurea therapy in SCA. Glomerular filtration rate, urine microalbumin, and serum cystatin C were measured before initiating hydroxyurea therapy and then repeated after 3 years. Baseline and Year 3 values for HUSTLE subjects were compared using the Wilcoxon Signed Rank test. Associations between continuous variables were evaluated using Spearman correlation coefficient. Twenty‐three children with SCA (median age 7.5 years, range, 2.5–14.0 years) received hydroxyurea at maximum tolerated dose (MTD, 24.4 ± 4.5 mg/kg/day, range, 15.3–30.6 mg/kg/day). After 3 years of treatment, GFR measured by 99m Tc‐DTPA decreased significantly from 167 ± 46 mL/min/1.73 m 2 to 145 ± 27 mL/min/1.73 m 2 ( P = 0.016). This decrease in GFR was significantly associated with increase in fetal hemoglobin ( P = 0.042) and decrease in lactate dehydrogenase levels ( P = 0.035). Urine microalbumin and cystatin C levels did not change significantly. Hydroxyurea at MTD is associated with a decrease in hyperfiltration in young children with SCA. Am. J. Hematol., 88:116–119, 2013. © 2012 Wiley Periodicals, Inc.