Kidney biopsy findings in children with sickle cell disease: a Midwest Pediatric Nephrology Consortium study.
Children
Chronic kidney disease
Glomerular hyperfiltration
Glomerulopathy
Proteinuria
Sickle cell disease
Journal
Pediatric nephrology (Berlin, Germany)
ISSN: 1432-198X
Titre abrégé: Pediatr Nephrol
Pays: Germany
ID NLM: 8708728
Informations de publication
Date de publication:
08 2019
08 2019
Historique:
received:
11
09
2018
accepted:
11
03
2019
revised:
09
03
2019
pubmed:
5
4
2019
medline:
6
6
2020
entrez:
5
4
2019
Statut:
ppublish
Résumé
Renal damage is a progressive complication of sickle cell disease (SCD). Microalbuminuria is common in children with SCD, while a smaller number of children have more severe renal manifestations necessitating kidney biopsy. There is limited information on renal biopsy findings in children with SCD and subsequent management and outcome. This is a multicenter retrospective analysis of renal biopsy findings and clinical outcomes in children and adolescents with SCD. We included children and adolescents (age ≤ 20 years) with SCD who had a kidney biopsy performed at a pediatric nephrology unit. The clinical indication for biopsy, biopsy findings, subsequent treatments, and outcomes were analyzed. Thirty-six SCD patients (ages 4-19 years) were identified from 14 centers with a median follow-up of 2.6 years (0.4-10.4 years). The indications for biopsy were proteinuria (92%) and elevated creatinine (30%). All biopsies had abnormal findings, including mesangial hypercellularity (75%), focal segmental glomerulosclerosis (30%), membranoproliferative glomerulonephritis (16%), and thrombotic microangiopathy (2%). There was increased use of hydroxyurea, angiotensin-converting-enzyme inhibitors, and angiotensin receptor blockers following renal biopsy. At last follow-up, 3 patients were deceased, 2 developed insulin-dependent diabetes mellitus, 6 initiated chronic hemodialysis, 1 received a bone marrow transplant, and 1 received a kidney transplant. Renal biopsies, while not commonly performed in children with SCD, were universally abnormal. Outcomes were poor in this cohort of patients despite a variety of post-biopsy interventions. Effective early intervention to prevent chronic kidney disease (CKD) is needed to reduce morbidity and mortality in children with SCD.
Sections du résumé
BACKGROUND
Renal damage is a progressive complication of sickle cell disease (SCD). Microalbuminuria is common in children with SCD, while a smaller number of children have more severe renal manifestations necessitating kidney biopsy. There is limited information on renal biopsy findings in children with SCD and subsequent management and outcome.
METHODS
This is a multicenter retrospective analysis of renal biopsy findings and clinical outcomes in children and adolescents with SCD. We included children and adolescents (age ≤ 20 years) with SCD who had a kidney biopsy performed at a pediatric nephrology unit. The clinical indication for biopsy, biopsy findings, subsequent treatments, and outcomes were analyzed.
RESULTS
Thirty-six SCD patients (ages 4-19 years) were identified from 14 centers with a median follow-up of 2.6 years (0.4-10.4 years). The indications for biopsy were proteinuria (92%) and elevated creatinine (30%). All biopsies had abnormal findings, including mesangial hypercellularity (75%), focal segmental glomerulosclerosis (30%), membranoproliferative glomerulonephritis (16%), and thrombotic microangiopathy (2%). There was increased use of hydroxyurea, angiotensin-converting-enzyme inhibitors, and angiotensin receptor blockers following renal biopsy. At last follow-up, 3 patients were deceased, 2 developed insulin-dependent diabetes mellitus, 6 initiated chronic hemodialysis, 1 received a bone marrow transplant, and 1 received a kidney transplant.
CONCLUSIONS
Renal biopsies, while not commonly performed in children with SCD, were universally abnormal. Outcomes were poor in this cohort of patients despite a variety of post-biopsy interventions. Effective early intervention to prevent chronic kidney disease (CKD) is needed to reduce morbidity and mortality in children with SCD.
Identifiants
pubmed: 30945006
doi: 10.1007/s00467-019-04237-3
pii: 10.1007/s00467-019-04237-3
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1435-1445Références
Arch Intern Med. 1990 Mar;150(3):501-4
pubmed: 2178577
Am J Pathol. 1974 Dec;77(3):357-74
pubmed: 4611224
Nephrol Dial Transplant. 2014 Jun;29(6):1211-8
pubmed: 24084325
J Am Soc Nephrol. 2016 Jun;27(6):1847-53
pubmed: 26586692
N Engl J Med. 1994 Jun 9;330(23):1639-44
pubmed: 7993409
Am J Hematol. 2014 Sep;89(9):907-14
pubmed: 24840607
J Pediatr. 1992 Mar;120(3):360-6
pubmed: 1538280
Pediatr Blood Cancer. 2005 Dec;45(7):982-5
pubmed: 15704213
Am J Hematol. 2017 Oct;92(10):E598-E599
pubmed: 28670697
J Am Soc Nephrol. 2006 Aug;17(8):2228-35
pubmed: 16837635
JAMA. 2014 Sep 10;312(10):1033-48
pubmed: 25203083
Kidney Int. 2001 Jun;59(6):2126-33
pubmed: 11380814
Am J Hematol. 2017 Sep;92(9):E520-E528
pubmed: 28589652
Pediatr Nephrol. 2016 Aug;31(8):1363-8
pubmed: 27011218
Am J Nephrol. 1987;7(2):110-5
pubmed: 3605231
J Am Soc Nephrol. 1991 May;1(11):1241-52
pubmed: 1932637
Pediatr Blood Cancer. 2008 Jun;50(6):1236-9
pubmed: 18293385
Am J Hematol. 2010 Jun;85(6):403-8
pubmed: 20513116
Kidney Int. 2005 Jun;67(6):2089-100
pubmed: 15882252
J Pediatr. 2000 Jun;136(6):749-53
pubmed: 10839871
Blood. 2013 Jul 11;122(2):282-92
pubmed: 23692858
J Am Soc Nephrol. 2012 Jun;23(6):989-96
pubmed: 22499586
Blood Cells Mol Dis. 2018 Mar;69:65-70
pubmed: 28951038
N Engl J Med. 1992 Apr 2;326(14):910-5
pubmed: 1542341
Am J Med. 1975 Nov;59(5):650-9
pubmed: 128292
Clin J Am Soc Nephrol. 2011 Nov;6(11):2628-33
pubmed: 21940843
BMC Nephrol. 2016 Sep 06;17(1):125
pubmed: 27600725
Clin J Am Soc Nephrol. 2016 Feb 5;11(2):207-15
pubmed: 26672090
Lancet. 2011 May 14;377(9778):1663-72
pubmed: 21571150
Pediatr Nephrol. 2011 Aug;26(8):1285-90
pubmed: 21559933
Nephrol Dial Transplant. 2013 Apr;28(4):1039-46
pubmed: 23345624
Blood. 1994 Jul 15;84(2):643-9
pubmed: 7517723
BMC Nephrol. 2014 Nov 21;15:184
pubmed: 25416588
Lancet. 1993 May 15;341(8855):1237-40
pubmed: 8098391
Medicine (Baltimore). 2005 Nov;84(6):363-76
pubmed: 16267411
Lancet. 1995 Aug 19;346(8973):475-6
pubmed: 7637482
Pediatr Blood Cancer. 2017 Dec;64(12):
pubmed: 28612449
Nephron. 1985;39(4):352-5
pubmed: 3982580
Blood. 2006 Feb 15;107(4):1651-8
pubmed: 16166585
Pediatr Nephrol. 2017 Aug;32(8):1451-1456
pubmed: 28238158
J Am Soc Nephrol. 2009 Mar;20(3):629-37
pubmed: 19158356
Am J Hematol. 2019 Jan;94(1):E27-E29
pubmed: 30359463
Kidney Int. 2018 Jul;94(1):170-177
pubmed: 29735307
Pediatr Blood Cancer. 2008 Feb;50(2):293-7
pubmed: 17554794
Blood. 2010 Mar 25;115(12):2354-63
pubmed: 19903897
Blood. 1998 Jan 1;91(1):288-94
pubmed: 9414296
Br J Haematol. 2011 Nov;155(3):386-94
pubmed: 21910715
Medicine (Baltimore). 2010 Jan;89(1):18-27
pubmed: 20075701