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| LETTER TO EDITOR |
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| Ahead of print publication |
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Microalbuminuria among children and adolescents with sickle cell disease
Mahmood Dhahir Al-Mendalawi, Mohammed Jalal Al-Khalidi
Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, Baghdad, Iraq
| Date of Submission | 07-Feb-2023 |
| Date of Acceptance | 13-Mar-2023 |
| Date of Web Publication | 11-Apr-2023 |
Correspondence Address:
Mahmood Dhahir Al-Mendalawi,
Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, P. O. Box: 55302, Baghdad Post Office, Baghdad
Iraq
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/ijh.ijh_14_23
Sir,
It was interesting to read the article by Hassan et al. that your prestigious journal recently published.[1] The authors studied the frequency of microalbuminuria (MA) among Iraqi pediatric patients with sickle cell disease (SCD) and determined the risk factors associated with MA among these patients. They found that the frequency of MA was high (32.5%) among the studied patients. Female gender, nutritional factors, iron overload, and painful episodes were the main risk factor for MA.[1] Apart from the cross-sectional nature of the study, we believe that the following five points could debate the reliability of the study findings. First, the studied patients did not have a long follow-up period to evaluate the progression of MA; a longer follow-up could have provided more information. Second, the authors employed twice spot urine albumin-to-creatinine ratio (ACR) estimations for patients. Taking into account, urinary ACR variability[2] and estimating urinary ACR in replicates could improve the correctness of albuminuria classification. It is likely that the authors did not want to put too much of a burden on the patients they studied by collecting urine samples frequently during steady-state medical visits. Third, a significant number of Iraqi pediatric SCD patients experience irregular medical visits and poor compliance with scheduled blood transfusions and/or drug therapy. As a result, SCD patients will be at increased risk for various organ injuries and complications, including MA.[3] Fourth, it was not obvious whether the studied clinical data taken by directly interviewing patients/parents or reviewing the patient's medical files in the related hematology center were available for all participants as any missing data for a subset of participants could impair the correlation of MA with these data. Fifth, the linkage between different genetic modifiers, such as HMOX1, APOL1, HBA1, and HBA2 variants, and onset and progression of various SCD-related nephropathies, including MA must not be overlooked.[4] Extensive genetic studies are needed to verify that linkage among Iraqi pediatric SCD patients. Despite the already mentioned points, the reported significant frequency of MA (32.5%) in SCD patients[1] should trigger the need to consider screening SCD patients for nephropathy to preserve renal function and lessen the future risk of uremia.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Hassan MK, Al-Naama LM, Jawad SM. Microalbuminuria among children and adolescents with sickle cell disease. Iraqi J Hematol 2022;11:103-9.  [Full text] |
| 2. | Naresh CN, Hayen A, Weening A, Craig JC, Chadban SJ. Day-to-day variability in spot urine albumin-creatinine ratio. Am J Kidney Dis 2013;62:1095-101. |
| 3. | Allali S, Taylor M, Brice J, de Montalembert M. Chronic organ injuries in children with sickle cell disease. Haematologica 2021;106:1535-44. |
| 4. | Ataga KI, Saraf SL, Derebail VK. The nephropathy of sickle cell trait and sickle cell disease. Nat Rev Nephrol 2022;18:361-77. |
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