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Detection of occult kidney injury in glucose 6 phosphate dehydrogenase deficiency anemia.

AmeerIsam AlAasam, Sultan Mohsin Ghanim, Seba Abdulkadhem, Jasim Mohammed Hashim, Majid Abdul Hameed Al Kufy, AlaaJumaah Manji Nasrawi*

Patients with Glucose-6-Phosphatase Dehydrogenase (G6PD) enzyme deficiency may develop hemolysis after administering different food, drugs, and herbs. Renal damage could be mild, resolving after administration of high-volume hydration and alkylating agents, or be severe and life-threatening due to acute renal failure. Materials and Methods: All children older than 28 days of age who were experiencing the first episode of the hemolytic crisis were enrolled in this prospective cohort study. In a period between February to May 2017. An acute hemolytic crisis is defined as the acute presence of pallor or jaundice, tea-color urine, normochromic normocytic anemia, reticulocytosis, indirect hyperbilirubinemia, and normal liver function test. Demographic information and laboratory investigation were taken to assess renal damage. Results: Totally, fifty children were included in the study, there was a significant decrease in GFR during the hemolytic crisis (mean=56.1 ml/min/1.73 m2), but the value increased to reach near normal (but still less than normal) during the next three weeks (mean=82.9 ml/min/1.73 m2). Surprisingly, the serum creatinine and BUN during the crisis and three weeks later were in the normal range. Discussion: In the recent survey, we found that the mean of GFR increased but did not reach the normal range three weeks after the hemolysis, although sCr levels were in the normal range. Therefore, we thought that G6PD deficiency per se might have an adverse outcome on the kidney functions. This finding was consistent with the study conducted by Hakeem et al., showing that the damage to the kidneys persisted even after the cessation of hemolysis, while the level of cystatin C was significantly higher compared to the control group fourteen days after hemolysis.