Renal Dysfunction in Pediatric Patients in Iraq With β-Thalassemia Major and Intermedia

Background With optimum transfusion and chelation therapy, the survival of I3-thalassemia patients and the incidence of various complications, including renal complications, have improved. Objectives To investigate renal involvement in I3-thalassemia patients using serum and urinary biochemical markers of glomerular and tubular dysfunction.Methods This case-control study included 69 I3-thalassemia major (I3-TM) patients, 23 I3-thalassemia intermedia (I3 -TI) patients, and 100 healthy controls, all ranging from 1 to 16 years in age. Blood urea nitrogen (BUN), serum ferritin, serum and urinary levels of creatinine (Cr), uric acid (UA), calcium (Ca), phosphorus (Ph), magnesium (Mg), sodium (Na), and potassium (K), and the urinary albumin/creatinine ratio were evaluated.Results The BUN level and the urinary Na/Cr, K/Cr, Ca/Cr, Mg/Cr, Ph/Cr, albumin/Cr, and UA/Cr ratios were significantly higher in the I3-thalassemia patients than in the controls. In contrast, the serum Na, K, Ca, and Mg levels were significantly lower in the patients (P<0.05). An elevated urinary UA/Cr ratio was found in 61.9% of I3-thalassemia patients, and an elevated urinary Ca/Cr, and urinary albumin/Cr ratio was found in 53.2%. An elevated Na/Cr ratio was found in 41.3%. The serum and urinary renal markers showed no significant differences between patients with I3-TM and I3-TI, except for microscopic hematuria, which was significantly higher in I3-TI patients (34.8%) than in I3-TM patients (13%), P>0.02. At an older age, high serum ferritin levels and deferoxamine therapy were associated with significant tubular and glomerular dysfunction in I3-thalassemia patients.Conclusions Pediatric patients with I3-thalassemia have significantly abnormal tubular and glomerular functions, necessitating early detection and monitoring to prevent/reverse renal function deterioration.

Automated summary

This study found that patients with I3-thalassemia have renal involvement and abnormal tubular and glomerular functions. Especially in older age, with high serum ferritin levels and deferoxamine therapy, the renal function deterioration was more significant.