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With sickle cell disease (SCD), the complications seem endless. As an adult with SCD or the parent of a child with the condition, it’s important to know what to watch for to protect your own health or your child’s.
Unfortunately, SCD can damage the kidneys. By learning the signs of kidney problems and what tests can help detect kidney damage, you’ll be better prepared for your next doctor’s visit.
In this article, we’ll cover how SCD can affect the kidneys and the risk of developing kidney disease. We’ll also discuss signs of kidney damage and tests your SCD treatment team may recommend.
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The kidneys are two bean-shaped organs that filter and clean your blood. Inside the kidneys are delicate filters that remove waste products and water to make urine.
In SCD, red blood cells (RBCs) are hard, C-shaped, and less flexible than normal cells. These abnormal cells can get stuck in blood vessels, blocking blood flow through them.
The kidneys have many tiny blood vessels in and around them. When sickle-shaped RBCs block blood flow to the kidneys, kidney tissue can’t get the oxygen it needs. This can lead to kidney damage.
Sickle cell nephropathy is the term for when SCD begins affecting your kidneys. It’s important to diagnose and treat kidney issues early. If left untreated, you or your child can eventually develop chronic kidney disease (CKD).
Acute kidney injury (AKI) can happen suddenly. CKD, on the other hand, develops over time. The American Kidney Fund notes that 20 percent to 25 percent of people with SCD eventually develop CKD.
Kidney disease can be hard to spot early because many people don’t experience any symptoms. Routine urine tests might find proteinuria, or high levels of protein in the urine.
As kidney damage gets worse over time, symptoms may become more noticeable.
Possible early signs that you or your child may have kidney disease include:
Other signs of sickle cell nephropathy and kidney problems may include:
People with SCD tend to have lower blood pressure than average. If you have high blood pressure, it may be a warning sign of kidney problems.
When living with SCD, it’s important to have your kidney function monitored. Regular blood and urine tests help your treatment team track your overall health and any changes over time.
Creatinine is a waste product produced by muscle breakdown. Healthy kidneys filter creatinine from your blood. A normal creatinine level depends on your age, sex, and how much muscle tissue you have.
When someone has kidney disease, the kidneys can’t remove as much creatinine as they should. This waste product builds up in the bloodstream, which can be measured with a blood test.
A higher creatinine level can point to kidney disease. Your doctor will use this test — along with others — to get an overall picture of your kidney function.
Your estimated glomerular filtration rate (eGFR) also shows how well your kidneys are working. It estimates how well your kidneys filter your blood.
For adults, doctors calculate eGFR using a formula based on factors including age, sex, and creatinine. In general, a lower eGFR can mean reduced kidney function. Your healthcare team will interpret your eGFR along with your other test results and health history.
When the filters inside the kidneys become damaged, proteins and blood can leak out into the urine. A urine test, or urinalysis, can detect them.
Blood in the urine is a common sign of kidney injury and disease. You may or may not be able to see the blood.
Albumin is a protein found in your blood that shouldn’t be in urine. Extra protein in the urine can make it look foamy or bubbly.
A urine albumin-creatinine ratio (uACR) helps identify kidney damage. The uACR compares albumin with creatinine in a urine sample. A high uACR may be an early sign of kidney disease, even if eGFR is normal.
The kidneys control electrolyte levels. Electrolytes need to be balanced for normal organ and muscle function. In kidney disease, electrolyte levels can become too low or too high.
Electrolytes that may be checked for kidney problems include:
Sickled cells from SCD can block the vessels supplying blood to the kidneys. Imaging tests give doctors a clearer picture of blood flow to the kidneys and any signs of damage. Your doctor may order:
When living with SCD, it’s important to protect the kidneys from damage as much as possible. Taking SCD medications, going to regular health checkups, and watching for signs of kidney damage are all important.
Your doctor or your child’s SCD specialist may recommend:
Everyone’s SCD treatment plan looks different, and the plan may change if you’ve developed kidney disease. Your doctor or your child’s specialist will work with you to create an individualized treatment plan for SCD and kidney health.
Talk to your doctor or your child’s SCD specialist about your kidney function and the risk of kidney disease. The risk varies from person to person, and your doctor can explain how it may affect you or your child. Make sure your doctor knows about any family history of kidney disease, other medical conditions, and all the medications you take, since these details can help them understand your kidney health.
Many people and parents of children with SCD have had their symptoms and experiences dismissed by healthcare professionals. Your health and your child’s health matter. Be sure to mention any new or worsening symptoms that may be related to kidney disease, even if they seem mild.
You can also ask for a referral to a nephrologist (kidney specialist), preferably one who has experience treating people with SCD. Together, you can manage your kidney health and reduce the risk of further damage.
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