According to the ASH guidelines, when is albuminuria screening indicated in the management of sickle cell disease (SCD)?

Updated: May 12, 2021
  • Author: Joseph E Maakaron, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

The ASH guideline panel did not assess the evidence to inform decisions about albuminuria screening, but notes that Kidney Disease Improving Global Outcomes (KDIGO) guidelines state that albuminuria should be confirmed by either a first morning urine sample or 2 consecutive untimed urine samples. The National Heart, Lung, and Blood Institute (NHLBI) 2014 expert panel report states that screening for albuminuria should occur annually beginning at 10 years of age for patients with SCD. However, more recent evidence suggests a potential benefit of earlier screening.

For children and adults with SCD and albuminuria, the ASH guideline panel suggests the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs).

The initiation of ACEIs and ARBs for patients with SCD requires adequate follow-up and monitoring of side effects (eg, hyperkalemia, cough, hypotension).

As recommended by the KDIGO guidelines for the general population, the following attention to baseline and changes in renal function are appropriate when prescribing ACEIs or ARBs for patients with SCD:

  • Start medication at a lower dose in individuals with a glomerular filtration rate (GFR) of < 45 mL/min/1.73 m 2
  • Assess GFR and measure serum potassium within 1 week of starting medication or following any dose escalation
  • Temporarily suspend medication during interval illness, planned IV radiocontrast administration, or bowel preparation for colonoscopy or prior to major surgery.

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