Glomerular hyperfiltration in adult sickle cell anemia: a frequent hemolysis associated feature

Clin J Am Soc Nephrol. 2010 May;5(5):756-61. doi: 10.2215/CJN.08511109. Epub 2010 Feb 25.


Background and objectives: Sickle cell anemia-associated nephropathy is a growing matter of concern because renal failure affects most aging sickle cell anemia patients. Glomerular damage is a common feature revealed by a microalbuminuria or a macroalbuminuria. Although glomerular hyperfiltration has been described for decades in this population, its prevalence in young adults is unknown.

Design, setting, participants, & measurements: To address this issue, as well as the clinical and biologic correlates of hyperfiltration, a single-center, cross-sectional study of 280 homozygous SS disease patients was performed.

Results: The prevalence of hyperfiltration assessed by Modification of Diet in Renal Disease estimated GFR was 51%. Among patients with hyperfiltration, 49% had hyperfiltration alone, whereas 36% and 15% had an associated microalbuminuria or macroalbuminuria, respectively. Estimated GFR sensitivity and specificity for hyperfiltration were 94% and 63%, respectively, in a selected subgroup of 48 patients (measured GFR was assessed by urinary (51)Cr EDTA clearance). In patients with no albuminuria, hyperfiltration status was significantly associated with a young age (years), the absence of alpha thalassemia, a lower hemoglobin level (g/dl), and a lower fetal hemoglobin. The role of chronic hemolysis was further strengthened by multivariate analysis showing a correlation between estimated GFR and a low plasma fetal hemoglobin level, a young age, and a high reticulocyte count (r(2) = 0.54).

Conclusions: Together, the data suggest that the pathophysiology of hyperfiltration would rather be attributable to the hemolysis-associated vasculopathy rather than a viscosity-vaso-occlusive process.

MeSH terms

  • Adolescent
  • Adult
  • Albuminuria / blood
  • Albuminuria / epidemiology*
  • Albuminuria / physiopathology
  • Anemia, Sickle Cell / blood
  • Anemia, Sickle Cell / epidemiology*
  • Anemia, Sickle Cell / genetics
  • Anemia, Sickle Cell / physiopathology
  • Cross-Sectional Studies
  • Female
  • France / epidemiology
  • Glomerular Filtration Rate*
  • Hemoglobin, Sickle / genetics
  • Hemolysis*
  • Homozygote
  • Humans
  • Kidney / physiopathology*
  • Linear Models
  • Logistic Models
  • Male
  • Middle Aged
  • Prevalence
  • Renal Insufficiency / blood
  • Renal Insufficiency / epidemiology*
  • Renal Insufficiency / genetics
  • Renal Insufficiency / physiopathology
  • Risk Assessment
  • Risk Factors
  • Young Adult


  • Hemoglobin, Sickle