First evidence of subclinical renal tubular injury during sickle-cell crisis

Vincent Audard (1, 2) , Stéphane Moutereau (3) , Gaetana Vandemelebrouck (4, 5) , Anoosha Habibi (6, 7) , Mehdi Khellaf (8) , Philippe Grimbert (2, 1) , Yves Levy (9) , Sylvain Loric (3) , Bertrand Renaud (8) , Philippe Lang (2, 1) , Bertrand Godeau (7) , Frédéric Galactéros (4, 6, 7) , Pablo Bartolucci (4, 6, 7)

1 Service de Néphrologie et Transplantation
2 IMRB - Institut Mondor de Recherche Biomédicale
3 Departement de Biochimie-Pharmacotoxicologie
4 Unité INSERM 955
5 EFS - Etablissement Français du Sang
6 Centre de Référence des Syndromes Drépanocytaires Majeurs
7 Service de Médecine Interne
8 Service d'Accueil des Urgences
9 Service d'immunologie clinique [Créteil]

Background
The pathophysiologic mechanisms classically involved in sickle-cell nephropathy include endothelial dysfunction and vascular occlusion. Arguments demonstrating that ischemia-reperfusion injury-related kidney damage might coincide with vaso-occlusive crisis (VOC) are lacking.
Methods
In this prospective study, we sought to determine whether tubular cells and glomerular permeability might be altered during VOC. Urine neutrophil gelatinase-associated lipocalin (NGAL) levels and albumin-excretion rates (AER) of 25 patients were evaluated prospectively during 25 VOC episodes and compared to their steady state (ST) values.
Results
During VOC, white blood-cell counts (WBC) and C-reactive protein (CRP) were significantly higher than at ST but creatinine levels were comparable. Urine NGAL levels were significantly increased during VOC vs ST (P = 0.007) and remained significant when normalized to urine creatinine (P = 0.004), while AER did not change significantly. The higher urine NGAL concentration was not associated with subsequent (24-48 hour) acute kidney injury. Univariate analysis identified no significant correlations between urine NGAL levels and laboratory parameters during VOC.
Conclusions
These results demonstrated that subclinical ischemia-reperfusion tubular injury is common during VOC and highlight the importance of hydroelectrolyte monitoring and correction during VOC.

Domaines: Génétique

Vincent Audard, Stéphane Moutereau, Gaetana Vandemelebrouck, Anoosha Habibi, Mehdi Khellaf, et al.. First evidence of subclinical renal tubular injury during sickle-cell crisis. Orphanet Journal of Rare Diseases, 2014, 9 (1), pp.67. ⟨inserm-00986267⟩