Faculty Collaboration Database

Hyperuricemia is associated with a lower glomerular filtration rate in pediatric sickle cell disease patients. Pediatr Nephrol 2020 May;35(5):883-889

Date

01/22/2020

Pubmed ID

31960140

DOI

10.1007/s00467-019-04432-2

Scopus ID

2-s2.0-85078620591 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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).

CONCLUSION: 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.

Author List

Kaspar CDW, Beach I, Newlin J, Sisler I, Feig D, Smith W

Author

Cristin Duongba Wendel Kaspar MD Adjunct Assistant Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Albuminuria
Anemia, Sickle Cell
Blood Transfusion
Child
Cohort Studies
Cross-Sectional Studies
Female
Glomerular Filtration Rate
Gout Suppressants
Humans
Hyperuricemia
Kidney Diseases
Male
Prevalence
Renal Elimination
Risk Factors
Uric Acid