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Research Article| Volume 76, ISSUE 4, P632-640, October 1970

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Renal circulatory studies in young adults with sickle cell anemia

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      Abstract

      Renal hemodynamics were examined in young adult patients with sickle cell anemia (SS hemoglobin) during a stable period of their disease and compared with those of control subjects. There was no evidence of renal disease except for the concentrating defect, which was present in every patient studied. The previously described elevation in glomerular filtration rate (GFR) and in renal plasma flow (RPF) was confirmed in these patients, while total renal blood flow (RBF) was shown to be normal or moderately increased. The additional perfusion of blood through the kidney was demonstrated by an increase in cortical plasma flow (CPAH). The renal extraction of p-aminohippurate (EPAH) was normal or low in every patient studied. Insofar as EPAH represents the intrarenal distribution of blood between cortex and medulla, noncortical plasma flow (NCPF), including medullary blood flow (MBF), was either normal or increased. None of the patients had a decreased MBF as was previously believed. While the mechanism responsible for the increase in renal hemodynamics in patients with sickle cell anemia remains unknown, a causal relationship may exist between these circulatory changes in the renal medulla and the associated impairment in urinary concentration. These changes in the present study would seem to indicate that the renal concentrating defect has a functional basis in early life which may be caused, at least in part, by an increase in MBF.
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      References

        • Hatch F.E.
        • Culbertson J.W.
        • Diggs L.W.
        Nature of the renal concentrating defect in sickle cell disease.
        J. Clin. Invest. 1967; 46: 336
        • Etteldorf J.N.
        • Tuttle A.H.
        • Clayton G.W.
        Renal hemodynamics in children with sickle-cell anemia.
        Amer. J. Dis. Child. 1952; 83: 185
        • Etteldorf J.N.
        • Smith J.D.
        • Tuttle A.H.
        • Diggs L.W.
        Renal hemodynamic studies in adults with sickle cell anemia.
        Amer. J. Med. 1955; 18: 243
        • McCrory W.W.
        • Goren N.
        • Gornfeld D.
        Demonstration of impairment of urinary concentrating ability, or “pitressin-resistance,” in children with sickle cell anemia.
        Amer. J. Dis. Child. 1953; 86: 512
        • Heinemann H.O.
        • Cheung M.W.
        Renal concentrating mechanism in sickle cell anemia.
        J. Lab. Clin. Med. 1957; 49: 923
        • Smith E.W.
        • Conley C.L.
        Clinical manifestations of sickle-cell disease.
        in: Conference on hemoglobin. National Academy of Sciences, Washington, D.C1958: 276
        • Whitten C.F.
        • Younes A.A.
        A comparative study of renal concentrating ability in children with sickle cell anemia and in normal children.
        J. Lab. Clin. Med. 1960; 55: 400
        • Levitt M.F.
        • Hauser A.D.
        • Levy M.S.
        • Polimeros D.
        The renal concentrating defect in sickle cell disease.
        Amer. J. Med. 1960; 29: 611
        • Perillie P.E.
        • Epstein F.H.
        Sickling phenomenon produced by hypertonic solutions: A possible explanation for the hyposthenuria of sicklemia.
        J. Clin. Invest. 1963; 42: 570
        • Thurau K.
        • Deetjen P.
        Die diurese bei arteriellen Drucksteigerungen, Pflüger.
        Arch. Ges. Physiol. 1962; 274 (mit einem Beitrag von Günzler, H.): 567
        • Walser M.
        • Davidson D.G.
        • Orloff J.
        The renal clearance of alkali-stable Inulin.
        J. Clin. Invest. 1955; 34: 1520
        • Smith H.W.
        • Finkelstein N.
        • Aliminosa L.
        • Crawford B.
        • Graber M.
        The renal clearances of substituted hippuric acid derivatives and other aromatic acids in dog and man.
        J. Clin. Invest. 1945; 24: 288
        • Smith H.W.
        The kidney: Structure and function in health and disease.
        Oxford University Press, New York1951
        • Bolomey A.A.
        • Michie A.J.
        • Michie C.
        • Breed E.S.
        • Schreiner G.E.
        • Lauson H.D.
        Simultaneous measurement of effective renal blood flow and cardiac output in resting normal subjects and patients with essential hypertension.
        J. Clin. Invest. 1949; 28: 10
        • Bradley S.E.
        • Bradley G.P.
        Renal function during chronic anemia in man.
        Blood. 1947; 2: 192
        • Reubi F.C.
        Objections a la théorie de la séparation intrarénal des hématies et du plasma (Pappenheimer).
        Helvet. Med. Acta. 1958; 25: 516
        • Slotkoff L.M.
        • Eisner G.M.
        • Lilienfield L.S.
        PAH extraction ratio: An index of renal medullary blood flow?.
        Clin. Res. 1964; 12 (Abst.): 259
        • Thurau K.
        Renal hemodynamics.
        Amer. J. Med. 1964; 36: 698
        • Earley L.E.
        • Friedler R.M.
        Changes in renal blood flow and possibly the intrarenal distribution of blood during the natriuresis accompanying saline loading in the dog.
        J. Clin. Invest. 1965; 44: 929
      1. Pitcock, J., and Hatch, F. E.: Unpublished observations.

        • Leight L.
        • Snider T.H.
        • Clifford G.O.
        • Hellems H.K.
        Hemodynamic studies in sickle cell anemia.
        Circulation. 1954; 10: 653
      2. Hatch, F. E.: Unpublished data.

        • Johnson Jr., B.L.
        • Murray J.F.
        Renal function during acute normovolemic and hypervolemic anemia.
        Clin. Res. 1963; 11: 243
        • Thompson D.D.
        • Kavaler F.
        • Lozano R.
        • Pitts R.F.
        Evaluation of the cell separation hypothesis of autoregulation of renal blood flow and filtration rate: Blood flow, filtration rate and PAH extraction as functions of arterial pressure in normal and anemic dogs.
        Amer. J. Physiol. 1957; 191: 493
        • Keitel H.G.
        • Thompson D.
        • Itano H.A.
        Hyposthenuria in sickle cell anemia: A reversible renal defect.
        J. Clin. Invest. 1956; 35: 998
        • Van Eps L.W.Statius
        • Schouten H.
        • La Porte-Wijsman L.W.
        • Boudier A.M.Struyker
        The influence of red blood cell transfusions on the hyposthenuria and renal hemodynamics of sickle cell anemia.
        Clin. Chem. Acta. 1967; 17: 449
        • Barreras L.
        • Diggs L.W.
        • Lipscomb A.
        Plasma volume in sickle cell disease.
        Southern Med. J. 1966; 59: 456
      3. Diggs, L. W.: Personal communications.

        • Blumgart H.L.
        • Altschule M.D.
        Clinical significance of cardiac and respiratory adjustments in chronic anemia.
        Blood. 1948; 3: 329
        • Cargill W.H.
        Effect of the intravenous administration of human serum albumin on renal function.
        in: ed. 4. Proc. Soc. Exp. Biol. Med. 68. 1948: 189
        • Elpers M.J.
        • Selkurt E.E.
        Effects of albumin infusion on renal function in the dog.
        Amer. J. Physiol. 1963; 205: 153
        • Calcagno P.L.
        • McLaby J.
        • Kelly T.
        Glomerular filtration rate in children with sickle-cell disease.
        Pediatrics. 1950; 5: 127
        • Bernstein J.
        • Whitten C.F.
        A histologic appraisal of the kidney in sickle cell anemia.
        Arch. Path. 1960; 70: 407
        • Van Eps L.W.Statius
        • Pinedo-Veels C.
        • de Vries G.H.
        • deKoning J.
        Nature of concentrating defect in sickle cell nephropathy.
        Lancet. 1970; 1: 450
        • Schlitt L.
        • Keitel H.G.
        Pathogenesis of hyposthenuria in persons with sickle cell anemia or the sickle cell trait.
        Pediatrics. 1960; 26: 249