Alterations in Urinary Microalbumin and Serum Antioxidants in Sickle Cell Disease

of renal medulla.2 Studies in pediatric patients had revealed that renal damage starts during childhood and continues throughout life. Prolonged glomerular hyperfiltration in SCD during childhood and early adult years leads to glomerular injury, resulting in glomerular sclerosis, proteinuria, and progressive renal failure.3 Microalbuminuria is an early manifestation of sickle cell-related renal disease and is considered to be a risk factor for developing renal impairment in future.4,5 It has been reported that adult SCD patients with severe anemia have glomerular injury and proteinuria.6 A study in pediatric patients with SCD found that proteinuria was significantly associated with lower hemoglobin (Hb) concentration, higher mean corpuscular volume, and higher leukocyte count.7 The incidence of proteinuria increases with advancing age. As proteinuria in the early stages of nephropathy is a hallmark of future deterioration of renal function, it is important to detect this early with routine surveillance. Intervention at this stage may prevent or at least delay the renal damage. Likewise, changes in the plasma level of vitamin antioxidants like vitamins A, C, and E have been noticed in sickle cell patients. Decrease in the level of these antioxidants in SCD patients could cause oxidative stress. The depletion in the levels of these antioxidants may account for some of the observed manifestations of SCA, such as increased susceptibility to infection and hemolysis.8 Ascorbic acid could contribute to reduction of the increased oxygen free radicals generated in sickle red blood cells (RBC) and to the recycling of vitamin E in the cells, while renal loss could contribute to the low plasma levels. The compound is known to protect RBC against hydrogen peroxide-induced hemolysis. Also, it had a significant stimulatory effect on the rate of glucose oxidation by the pentose phosphate shunt, especially in the sickle RBC. Another parameter, uric acid, has been known to be associated with the pathophysiology of vascular occlusion in sickle cell anemia.9 Studies have revealed the elevation of uric acid in sickle cell patients compared with normal control groups.10 Higher concentration of urate is found to possess antisickling activity on sickle cell erythrocytes and is beneficial to sickle cell patients in a compensatory way.11 The prevalence of sickle cell anemia is approximately 10 to 12% in the population of Chhattisgarh.12 Therefore, in the present study, an attempt has been made to determine some biochemical parameters, such as microalbumins and 1Director Professor , 2,4Associate Professor, 3Student 1-4Department of Biochemistry, Pt. Jawahar Lal Nehru Memorial Medical College, Raipur, Chhattisgarh, India Corresponding Author: GK Sahu, Associate Professor Department of Biochemistry, Pt. Jawahar Lal Nehru Memorial Medical College, Raipur, Chhattisgarh, India, Phone: +919826173912, e-mail: [email protected] ABSTRACT