Frequency of glomerular dysfunction in children with beta thalassaemia major

ABSTRACT

This study investigated the frequency of glomerular dysfunction in children with beta thalassaemia major [beta -TM] by using different markers and correlating them with serum ferritin and iron chelation therapy. The study, carried out between August 2011 and May 2012, included 100 patients with beta -TM, in two groups. Group Ia [n = 62] received chelation therapy [deferoxamine]. Group Ib [n = 38] received followup care at the Pediatric Hematology Outpatient Clinic, Minia University Children's Hospital, Egypt. Group II included 50 apparently healthy controls, age- and sex-matched to Group I. All patients underwent a thorough history-taking, clinical examination and laboratory investigations. Compared to Group II, Groups Ia and Ib had significantly higher levels of cystatin C, serum creatinine and serum ferritin, and a higher albumin/ creatinine ratio in their urine, and a significantly lower estimated glomerular filtration rate [eGFR] and creatinine clearance [P <0.05]. Moreover, Group ?a had a significantly lower eGFR and creatinine clearance than Group Ib. Cystatin C had a highly significant strong negative correlation with eGFR and creatinine clearance and a significantly strong positive correlation with serum ferritin, and a higher sensitivity and specificity than serum creatinine and creatinine clearance for small changes in GFR. beta -TM patients had a high frequency of glomerular dysfunction-possibly attributable to chronic anaemia, iron overload or chelation therapy. Periodic renal assessment is mandatory to detect renal complications. Cystatin C is a promising marker to monitor glomerular dysfunction, having a higher sensitivity and specificity than serum creatinine and creatinine clearance for small changes in GFR