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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 6  |  Issue : 2  |  Page : 289-294

Comparison of microalbuminuria, creatinine, and glomerular filtration rate between sickle cell disease patients and healthy individuals


1 Department of Clinical Chemistry, Faculty of Medical Laboratory Sciences, University of Gezira, Wad Medani; Departments of Clinical Chemistry, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosti, Sudan
2 Department of Medical Parasitology, Faculty of Medical Laboratory Sciences, University of Gezira; Department of Parasitology, Blue Nile National Institute for Communicable Diseases, University of Gezira, Wad Medani, Sudan
3 Department of Pathology, College of Medicine, Karary University, Khartoum, Sudan
4 Microbiology, Faculty of Medical Laboratory Sciences, University of El Imam El Mahdi, Kosti, Sudan

Date of Submission16-Mar-2022
Date of Acceptance15-May-2022
Date of Web Publication17-Jun-2022

Correspondence Address:
Mubarak Elsaeed Mustafa Elkarsany
Department of Pathology, College of Medicine, Karary University, Khartoum
Sudan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bbrj.bbrj_67_22

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  Abstract 


Background: Sickle cell disease is related to many health issues (such as stroke, severe infections, and sickle cell crisis) and elevated risk of death. This study was aimed to investigate and compare microalbuminuria (MAU), creatinine, and glomerular filtration rate (GFR) between sickle cell disease (SCD) patients and healthy individuals. Methods: A total of 156 cases and 156 control subjects were included. MAU, creatinine, GFR, and body mass index (BMI) were measured. Results: The estimated levels of MAU and creatinine were significantly higher in cases than controls, but the mean of BMI and GFR was significantly lower in cases than the control group. In patients of sickle cell disease, the mean MAU, GFR, creatinine, and BMI levels in females, rural area residents, and subjects aged 2–13 years were higher than controls, P < 0.05. MAU and GFR were also higher (P < 0.05) in males and subjects aged 14–25 years of study cases than controls. Conclusion: Accordingly, this study indicated the impact of SCD in MAU, creatinine, GFR, and BMI, which are significant in the diagnosis of nephropathy.

Keywords: Body mass index, creatinine, glomerular filtration rate, microalbuminuria, sickle cell disease


How to cite this article:
Ismail AM, Abakar AD, Elkarsany ME, Almugadam BS. Comparison of microalbuminuria, creatinine, and glomerular filtration rate between sickle cell disease patients and healthy individuals. Biomed Biotechnol Res J 2022;6:289-94

How to cite this URL:
Ismail AM, Abakar AD, Elkarsany ME, Almugadam BS. Comparison of microalbuminuria, creatinine, and glomerular filtration rate between sickle cell disease patients and healthy individuals. Biomed Biotechnol Res J [serial online] 2022 [cited 2022 Dec 9];6:289-94. Available from: https://www.bmbtrj.org/text.asp?2022/6/2/289/347724




  Introduction Top


Microalbuminuria (MAU) is an increase in urinary albumin than the normal limit.[1],[2] There are several ways to investigate MAU, which include urine dipstick.[1] MAU was related to chronic kidney disease (CKD) or kidney damage and now is documented as a risk indicator for CKD as well as its consequence.[2] CKD may progress to the end-stage kidney disease that needs transplantation or infrequent hemodialysis. Thus, the early detection of this disorder is critical to evade the renal failure and death. In human, the occurrence of MAU is documented as a risk sign for CKD as well as its complications.[2] CKD affects around 8%–16% of the worldwide population, and it is more in low- and middle-income than in high-income countries.[3]

Serum creatinine (SCr) is a metabolite of creatine, which is synthesized in some endothelial organs such as liver. It is production affects by many factors such as creatine ingestion in food and muscle function. The creatinine excretion depends on many factors including age and body mass.[4] In normal condition, there is a balance between production and excretion by glomeruli.[5] Approximately 10%–40% of urinary creatinine are attributable to tubular secretion which may be elevated in CKD leading to an unpredictable overestimation of glomerular filtration rate (GFR).[5] SCr is an available and reliable indicator of renal function.[5],[6],[7] Elevated SCr level is associated with abnormal renal function. SCr level is in contrary link to the clearance of creatinine. Indeed, when it is raised, GFR is declined, and this indicates renal damage. Practically, it is used to assess the severity of kidney damage, insufficiency of kidney function, and the progression of kidney disease.[3] Acute kidney injury (AKI) is identified if SCr increases by 0.3 mg/dl or over within 48 h or increases to 1.5-fold from baseline within 7 days.[5] GFR is also a known reliable marker for the evaluation of kidney function and renal disease. CKD identify when GFR of <60 mL/min/1.73 m2.[3] In differentiation between CKD and AKI, the kidney function tests should repeat within 2 weeks of the baseline result of estimated glomerular filtration rate <60 ml/min/1.73 m. CKD is confirmed also when the repeated blood test findings over 3 months are consistent.[8]

Sickle cell disease (SCD) is an illness result from abnormal inherited hemoglobinopathy, which leads to clinical sequelae of hemolysis and vaso-occlusive phenomena. Sickle cell disease is related to many health issues (such as stroke, severe infections, and sickle cell crisis) and elevated risk of death.[9],[10],[11],[12] Renal infarction and papillary necrosis are also frequent complications of SCD. The long-term consequences of SCD lead to sickle cell glomerulopathies, which may progress into chronic renal failure.[13],[14] Our study was aimed to investigate and compare MAU, creatinine, and GFR between sickle cell disease patients and healthy individuals.


  Methods Top


This was a case–control study. Our study was conducted in Kosti Teaching Hospital. This hospital locates in Kosti city. Kosti stands on the western side of the White Nile river; its population was 459,991,000.

Ethical issue

The present study was performed during January 2018 to December 2020 following the approval by the Ethics Review Committee of Kosti Teaching Hospital (Approval date: January 10, 2018).

Patient consent

Written informed consent was given by each participant.

Sampling

The study used convince sample type since it included those who attended Kosti Teaching Hospital through the study duration.

Study participants and data

All patients with sickle cell disease who attended Kosti Teaching Hospital were included. Non-SCD healthy individuals were also involved as a control group. The targeted participants in both the groups were aged 2–37 years and under steady state (no excise). In both groups, the excluded individuals include those under dialysis orhad a history of hypertension, CKD or other chronic diseases. Those with a history of radio or chemotherapy, or medication use (except folic acid or folic acid+hydroxyl urate for SCD) were also excluded. A total of 156 cases and 156 control subjects were included. Study data were collected by the direct interview using a questionnaire.

Laboratory analysis

Venous blood and urine samples were collected from each person. Samples collection and process were done as described before.[15] MAU and Creatinine were measured by using Biosystems kits (Biosystems, Barcelona, Spain) and Mindray BA88A semi automated biochemistry analyzer.

Data analysis

Data were analyzed by SPSS software version 21 and figures displayed by GraphPad Prism software (V 7). Normality test was performed and based on its findings, all of 2-indepndant sample T-, Mann-Whitney U, One-way ANOVA, nad Kruskal Wallis, and test were performed to evaluate the variation between data. P < 0.05 was considered statistically significant. ns: P > 0.05, *: P < 0.05, **: P < 0.01, ***: P < 0.001, ****: P < 0.0001.


  Results Top


Study subjects

The study enrolled a total of 312 subjects (156 SCD and 156 healthy controls), with ages ranging from 2 to 37 years. The mean age of the SCD and healthy control groups was 12.8 and 16.0 years, respectively. Males were more frequently than females in the ratio of 1.3:1 and 2.3:1 for the case and control groups, respectively [Table 1].
Table 1: Study subjects

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Relationship of microalbuminuria, creatinine, glomerular filtration rate, and body mass index with sickle cell disease

The estimated levels of MAU and creatinine were significantly higher in cases than controls [Figure 1]a and [Figure 1]b, but the mean of BMI and GFR was significantly lower in cases than the control group [Figure 1]c and [Figure 1]d. In patients of sickle cell disease, the mean of MAU, GFR, and creatinine levels in females, rural area residents, and subjects aged 2–13 years were higher than controls, P < 0.05. MAU and GFR were also higher (P < 0.05) in males and subjects aged 14–25 years of study cases than controls [Table 2].
Table 2: Relationship of microalbuminuria, creatinine, glomerular filtration rate, and body mass index with sociodemographic features of participants in both groups

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Figure 1: (a-d): Level of microalbuminuria (a), creatinine (b), GFR (c), and BMI (d) in both sickle cell disease patients and healthy individuals. Data are not normal. GFR: Glomerular filtration rate, BMI: Body mass index

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In the control group, the mean of MAU was higher in Shankhab tribe (P = 0.013), whereas creatinine was greater in Hausa (P = 0.022) and BMI was upper in Galleen tribe (P = 0.029). Likewise, creatinine, GFR, and BMI were higher (P < 0.05) in 26–37-year age group than others. Males (18.3) also showed low BMI than females (20.6), P = 0.004 [Table 2].

In the study group, GFR was higher in males (83.9) than females (72.5), P = 0.037. The mean of creatinine and BMI levels was greater in 26–37-year age group than other age groups, P < 0.000. While, GFR was significantly higher in subjects aged 14–25 years (94.6) than others. BMI was slightly higher (P = 0.011) in Hausa (17.2) compared to other ethnic groups [Table 2].

Those received blood transfusion linked to high level of creatinine and GFR but lower level of MAU, P < 0.011. Blood units were also significantly affecting the level of creatinine, GFR, and MAU. Indeed, creatinine, GFR, and MAU were significantly higher in those who received 2 units of blood [Figure 2]a, [Figure 2]b, [Figure 2]c, [Figure 2]d, [Figure 2]e, [Figure 2]f. There was no significant effect for treatment and duration of transfusion on MAU and BMI [Table 3].
Table 3: Relationship of treatment and duration of transfusion with microalbuminuria, creatinine, and body mass index

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Figure 2: (a-f): Study indices and blood transfusion. Relation of microalbuminuria (a), creatinine (b), and GFR (c) with blood transfusion receiving. Link of relation of microalbuminuria (d), creatinine (e), and GFR (f) with the units of blood. GFR: Glomerular filtration rate

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  Discussion Top


Microalbuminuria and creatinine

The renal system is responsible of several functions. The major functions include homeostasis of electrolytes and water, removal of waste, and acid–base balance. It also participate in several hormonal regulations.[16] In the practical, renal function tests are frequently performed to evaluate the water balance, renal disease, and acid–base balance disorders as well as in circumstances of infectious disease, surgery, trauma, and head injury. In this work, we planned to evaluate the level of MAU, creatinine, and GFR in SCD compared to healthy subjects. In this study, the estimated levels of MAU were significantly higher in cases than controls, which is in line with previous studies.[17],[18],[19],[20] A previous study reported MAU as 58.1% and 41.9% in non-Saudi Arabia and Saudi Arabia subjects, respectively.[21] According to previous studies, MAU is prevalent in sickle cell disease or anemia.[17],[18],[19],[20],[21],[22],[23],[24] This suggests the increased susceptibility of SCD patients to renal disorders. Similar to our study, Eke et al study showed no significant variation in MAU between gender in both the SCD and control groups[17] and Alzahrani et al study showed no significant different in rate of MAU between genders.[21] A prior study has been noticed that the odd of developing MAU is higher in males than females.[22] In a previous study, it has reported that the overall prevalence of MAU is more in male (80.6%) (P < 0.05).[24] However, our study shows no significant variation in MAU between age groups; several studies reported MAU increase with age,[17],[21] or proteinuria became more prevalent with increasing age.[23] On the other hand, Alkhunaizi et al study found that odd of developing MAU is higher in age >30 than <30[22] and Aloni et al study indicated that age significantly associated with MAU.[25] Likewise, Eke et al study showed that MAU is more in sicklers aged 14–17 than 4–8, 9–13 (P < 0.05).[17] Formerly, Alkhunaizi et al study showed that the odd of developing MAU is higher in BMI >25 than <25.[22] Similar to previous studies,[17],[19],[25],[26],[27],[28],[29] we found that creatinine is within normal value and it is higher in study cases than controls.[10],[29] Unlike our study, it is also reported higher in control than sicklers by Nnaji et al study.[18] Olawale et al study[19] also showed that plasma creatinine (in normal limit) and spot urine creatinine of the HbA genotype children were higher compared than HbS genotype children, P < 0.05. In agreement with Osman study,[29] creatinine is significantly higher in females of sicklers than controls.[29]

Body mass index and glomerular filtration rate

In agreement with Nnaji et al,[18] Olawale et al,[19] and Ocheke et al[20] studies we found that BMI is higher in control than sicklers, P < 0.05. Previously, Odetunde et al study found that 48% of the children with sickle cell anemia were underweight and only 13% of those with normal hemoglobin genotype were underweight,[30] which is in line to our findings.

In univariate analysis, Al Musawa et al study found that blood transfusion is associated with MAU but not creatinine or GFR,[24] whereas in the current study, blood transfusion only is linked with significant decline in creatinine. Similar to our results, the rate of MAU is higher in blood transfused subject than none in Alzahrani et al study.[21]


  Conclusion Top


Our study indicated the impact of SCD in MAU, creatinine, GFR, and BMI, which are significant in the diagnosis of prenephropathy. MAU and creatinine are significantly increased in SCD and GFR decreased. Further studies should include cysteine C and myoglobin to further verify SCD nephropathy.

Limitation of study

The current study limitation includes low sample size and lack of highly sensitive tests.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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