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Abnormal Ambulatory Blood Pressure and Early Renal Dysfunction in Sickle Cell Disease

Shiv Ram Krishna Dubey1,2, Neha Shrivastava1,3, Tanya Sharma4

  • 1Department of Pediatrics, ISN-Sister Renal Center, All India Institute of Medical Sciences (AIIMS), Madhya Pradesh, Bhopal, India.

Indian Journal of Pediatrics
|November 11, 2020
PubMed

Insights

Children with sickle cell disease (SCD) show high rates of ambulatory blood pressure monitoring (ABPM) abnormalities and early proteinuria. Regular screening for these conditions is crucial for preventing kidney damage in SCD patients.

Area of Science:

  • Pediatric Nephrology
  • Cardiovascular Health in Genetic Disorders
  • Hematology

Background:

  • Limited research exists on blood pressure (BP) in pediatric sickle cell disease (SCD), with conflicting findings.
  • Some studies indicate lower office BP, while others suggest masked hypertension and abnormal ambulatory BP monitoring (ABPM) in SCD patients.

Purpose of the Study:

  • To investigate 24-hour ABPM parameters in children with SCD.
  • To assess renal dysfunction in children with SCD.
  • To compare ABPM and renal function between children with SCD and healthy controls.

Main Methods:

  • A cross-sectional study involving 56 children (30 with SCD, 26 controls).
  • 24-hour ABPM was performed.
  • Renal function tests included serum creatinine, urea, urinary creatinine, urinary protein, and specific gravity.

Main Results:

  • Higher spot urinary protein to creatinine ratio in SCD patients (63.3%) compared to controls (p < 0.001).
  • Proteinuria detected in 25% of SCD patients under ten years old.
  • ABPM abnormalities observed: masked hypertension (6.6%), ambulatory hypertension (13.3%), ambulatory pre-hypertension (3.3%), and abnormal dipping (60%).
  • Significant correlations found between BMI-for-age Z-score and 24h systolic BP SDS (r=0.56, p=0.002); eGFR and 24h diastolic BP SDS (r=-0.52, p=0.038); and age and eGFR (r=0.54, p=0.025).

Conclusions:

  • ABPM abnormalities (hypertension, non-dipping, pre-hypertension) and early proteinuria are significant in pediatric SCD.
  • These findings highlight the need for routine screening of proteinuria and ABPM in SCD care.
  • Early detection and intervention are vital for preventing progressive renal damage in children with SCD.
Abstract

Keywords:
Ambulatory blood pressure monitoringRenal dysfunctionSickle cell disease

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