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Kidney iron deposition by R2* is associated with haemolysis and urinary iron

Christopher C Denton1,2, Jon A Detterich3,2, Thomas D Coates1,2

  • 1Department of Pediatrics, Divisions of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, CA, USA.

British Journal of Haematology
|November 20, 2020
PubMed

Insights

Kidney iron deposition in sickle cell disease (SCD) is linked to intravascular hemolysis, not just systemic iron overload. This finding highlights iron's potential role in SCD kidney damage.

Area of Science:

  • Nephrology
  • Hematology
  • Radiology

Background:

  • Kidney iron deposition, measured by R2* magnetic resonance imaging (MRI), is thought to stem from hemoglobin reabsorption after intravascular hemolysis.
  • In sickle cell disease (SCD), elevated R2* correlates with lactate dehydrogenase (LDH), a marker of hemolysis.

Purpose of the Study:

  • To investigate the relationship between kidney iron deposition, hemolysis markers, and urinary iron in non-transfused SCD patients.
  • To differentiate the contributions of systemic iron overload versus intravascular hemolysis to renal iron accumulation in SCD.

Main Methods:

  • Evaluated kidney R2* (MRI), urinary iron levels, and hemolysis markers (including LDH) in 62 non-transfused SCD patients.
  • Utilized multivariate analysis to identify factors associated with kidney R2*.

Main Results:

  • Kidney R2* was significantly associated with urinary iron and LDH levels.
  • Multivariate analysis showed these factors explained 55% of the variance in kidney R2* (R² = 0.55, P < 0.0001).

Conclusions:

  • Kidney iron deposition in SCD is strongly associated with intravascular hemolysis.
  • These findings suggest a significant role for iron in the development of nephropathy in sickle cell disease.

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