Abnormal Ambulatory Blood Pressure and Early Renal Dysfunction in Sickle Cell Disease
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ORIGINAL ARTICLE
Abnormal Ambulatory Blood Pressure and Early Renal Dysfunction in Sickle Cell Disease Shiv Ram Krishna Dubey 1,2 & Neha Shrivastava 1,3 & Tanya Sharma 4 & Girish C Bhatt 1 Abhijit P Pakhare 5 & SK Goel 6 & Deepti Joshi 4
&
Bhavna Dhingra 1 &
Received: 21 January 2020 / Accepted: 26 October 2020 # Dr. K C Chaudhuri Foundation 2020
Abstract Objectives There is sparsity of studies evaluating blood pressure in children with sickle cell disease (SCD), which have shown inconsistent results. Few of the studies have documented lower office blood pressure (BP) in SCD patients, whereas, others have shown presence of masked hypertension and abnormal ambulatory blood BP monitoring (ABPM). Thus, the present study was conducted to examine 24 h ABPM parameters and renal dysfunction in children with SCD and compare them with healthy controls. Methods A cross-sectional study was conducted on 56 children (30 children having SCD and 26 controls). ABPM and evaluation of renal functions including serum creatinine, serum urea, urinary creatinine, urinary protein and specific gravity was performed. Results Spot urinary protein to creatinine ratio was found to be higher in patients with SCD (63.3%) as compared to controls (p < 0.001). Proteinuria was observed in 1/4th of the SCD patients less than ten years of age. Masked hypertension was present in 2 (6.6%) patients, ambulatory hypertension in 4 (13.3%), ambulatory pre-hypertension in 1 (3.3%) and abnormal dipping in 60%. A statistically significant correlation of BMI for age Z-score and standard deviation score (SDS/Z) of 24 h systolic BP (r = 0.56, p = 0.002); estimated glomerular filtration rate (eGFR) with 24 h diastolic BP SDS (r = −0.52; p = 0.038) and age with e GFR (r = 0.54; p = 0.025) was found in the present study. Conclusions The present study corroborates that ABPM abnormalities (ambulatory hypertension, non-dipping pattern, ambulatory prehypertension) and early onset proteinuria are significant findings in patients with SCD. This underscores the importance of regular screening for proteinuria and ABPM in routine care, for early detection and prevention of progressive renal damage in SCD. Keywords Sickle cell disease . Renal dysfunction . Ambulatory blood pressure monitoring
Introduction * Girish C Bhatt [email protected] 1
Department of Pediatrics, ISN-Sister Renal Center, All India Institute of Medical Sciences (AIIMS), Madhya Pradesh Bhopal, India
2
Present address: Department of Pediatrics, Government Medical College, Vidisha, Madhya Pradesh, India
3
Present address: Department of Pediatrics, Gandhi Medical College, Bhopal, Madhya Pradesh, India
4
Department of Pathology & Lab Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
5
Department of Community & Family Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
6
Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
Sickle cell disease (SCD) is one of the co
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