Premium
Nephrin as a biomarker of sickle cell glomerulopathy in Malawi
Author(s) -
Heimlich J. Brett,
Chipoka Godwin,
Elsherif Laila,
David Emeraghi,
Ellis Graham,
Kamthunzi Portia,
Krysiak Robert,
Mafunga Pilirani,
Zhou Qingning,
Cai Jianwen,
Gopal Satish,
Key Nigel S.,
Ataga Kenneth I.
Publication year - 2018
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.26993
Subject(s) - medicine , nephrin , albuminuria , renal function , urinary system , creatinine , urology , odds ratio , glomerulopathy , gastroenterology , proteinuria , podocyte , kidney
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 50 th 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.