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Submitted: 18 Jan 2023
Accepted: 02 Jul 2023
ePublished: 22 Aug 2023
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J Renal Inj Prev. 2023;12(4): e32184.
doi: 10.34172/jrip.2023.32184

Scopus ID: 85174732695
  Abstract View: 1134
  PDF Download: 594

Original

Glomerulotubular function in transfusion-dependent thalassemia children: a prospective cohort study

Henny Adriani Puspitasari 1* ORCID logo, Ludi Dhyani Rahmartani 2 ORCID logo, Diashati Ramadhani Mardiasmo 3 ORCID logo, Pustika Amalia Wahidiyat 2 ORCID logo, Eka Laksmi Hidayati 1 ORCID logo

1 Division of Nephrology, Department of Child Health, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
2 Division of Hematology-Oncology, Department of Child Health, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
3 Medical Technology Cluster, Indonesia Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
*Corresponding Author: Henny Adriani Puspitasari, Email: henny.adriani01@ui.ac.id

Abstract

Introduction: Thalassemia is the most common hemoglobinopathy in Indonesia. Chronic anemia, iron overload, and treatment with iron chelating agents are factors that contribute to kidney dysfunction in children with transfusion-dependent thalassemia (TDT). Urine neutrophil gelatinase-associated lipocalin (uNGAL) and urine albumin-creatinine ratio (uACR) are markers of glomerular and tubular damage.

Objectives: To analyze the glomerulotubular function in TDT children.

Patients and Methods: This prospective cohort study recruited 40 TDT children aged ≤18 years old from thalassemia transfusion outpatient clinic, Dr. Cipto Mangunkusumo general hospital, Jakarta, Indonesia between February and June 2021. Disease history, treatment, and anthropometry were obtained during enrollment (T0). Blood and urine samples were taken at enrollment (T0) and at 1 (T1), 2 (T2), and 3 (T3) month follow-up appointments. Data analyzed were iron chelating agent, ferritin, hemoglobin, estimated glomerular filtration rate (eGFR ), uNGAL, uACR levels.

Results: We observed kidney hyperfiltration in more than 30% of the participants. Transfusion volume was the most dominant factor for eGFR (β=-0.974, P=0.022) and uNGAL (β=0.872, P=0.015). A low-proportion of albuminuria was found with duration of disease as the predominant factor (β=-0.946, P=0.000). Deferiprone (DFP) and deferasirox (DFX) showed comparable association with all kidney biomarkers.

Conclusion: The findings of this study indicate glomerular hyperfiltration in TDT children as the main early sign of glomerulotubular function impairment. In addition, a small proportion of proteinuria was also found in our study. Thus, both biomarkers should be part of long term kidney follow up in TDT children.


Implication for health policy/practice/research/medical education:

This study investigated the glomerulotubular function in children with TDT using kidney biomarkers uNGAL, uACR, and eGFR. The findings implied the need of long term kidney follow up in all TDT children.

Please cite this paper as: Puspitasari HA, Rahmartani LD, Mardiasmo DR, Wahidiyat PA, Hidayati EL. Glomerulotubular function in transfusion-dependent thalassemia children: a prospective cohort study. J Renal Inj Prev. 2023; 12(4): e32184. doi: 10.34172/jrip.2023.32184.

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