A randomized trial of captopril for microalbuminuria in normotensive adults with sickle cell anemia.

PURPOSE: Nephropathy is a common complication of sickle cell anemia and is often preceded by proteinurea. Our aim was to evaluate the effect of angiotensin-converting enzyme inhibition on microalbuminuria in sickle cell patients. PATIENTS AND METHODS: We performed a randomized, double-blind, placebo-controlled trial in 22 normotensive patients with sickle cell anemia and persistent microalbuminuria. Patients received captopril (25 mg/day) or placebo and were followed up for 6 months. Albuminuria, blood pressure, and serum creatinine and hemoglobin concentrations were measured at baseline and at 1, 3, and 6 months. The primary outcome variable was the 6-month change in albuminuria between the two groups. RESULTS: Baseline albuminuria was 121 (SD 66) mg per 24 hours in the captopril group and 107 (SD 86) mg per 24 hours in the placebo group. Microalbuminuria decreased from baseline in the captopril group but increased in the placebo group. The mean absolute change and the mean percentage change in microalbuminuria were significantly different between the two groups at 6 months (absolute change -45 mg per 24 hours in the captopril group versus +18 mg per 24 hours in the placebo group, P <0.01; and percentage change -37% in the captopril group versus +17% in the placebo group, P <0.01). The 95% confidence intervals (CI) for the difference in albuminuria between the two groups were 63 (CI 40 to 86) mg per 24 hours for the mean absolute change and 54% (CI 22% to 85%) for the mean percentage change. Blood pressure decreased slightly from baseline in captopril-treated patients and did not change in the placebo group. The change was significantly different between the two groups only for diastolic blood pressure at 6 months (P <0.01). CONCLUSION: Captopril reduces albuminuria and slightly decreases blood pressure in patients with sickle cell anemia. More studies are required to demonstrate the sustained benefit on protein excretion.

[Neuromyelopathy in the population of Noir-marron of Saint-Laurent du Maroni in French Guiana]. / Neuromyélopathies dans la population de Noirs marrons de Saint-Laurent du Maroni en Guyane française.

The neurological observations have been reported at André Bouron Hospital of Saint-Laurent du Maroni and at General Hospital of Cayenne during a period of 5 years. All patients belonged to the "Noir Marron" ethnic group and lived in the area of Saint-Laurent. There were six women and four men, aged 15-35 years. Neurological symptoms were isolated or associated to other organ failure. Neurological manifestations included retrobulbar optic neuropathy, spastic paraparesis, sensitive ataxia and cerebellar ataxia, psychiatric symptoms were observed. Other organs affected were cardiovascular, digestive, cutaneous or endocrinologic (thyroid). Diet consist mainly in cassava. Thiamin deficiency has been observed several times. Improvement of neurological deficits following thiamin administration points towards Thiamin as an etiological factor. Ethnological specificity of Saint-Laurent area may explain that such neurological manifestation have not been observed in the rest of the department.

[Arterial pressure and urinary excretion of albumin in adults with sickle cell disease]. / Pression artérielle et excrétion urinaire d'albumine chez les patients drépanocytaires adultes.

OBJECTIVE: The increase of urinary albumin excretion could be associated with morbidity in patients with sickle cell disease. The objective of this study was to evaluate the relation between blood pressure and urinary albumin excretion, and to estimate the prevalence of hypertension according to the level of urinary albumin excretion. METHODS: A cross-sectional study was carried in 77 patients with sickle cell disease (48 patients with haemoglobin SS, 29 with haemoglobin SC) et 30 controls with haemoglobin AA. The patients with sickle cell disease were divided into 3 groups according to urinary albumin excretion: less than 30 mg daily (group I: normoalbuminuria); from 30 to 300 mg daily (group II: microalbuminuria); above 300 mg daily (group III: macroalbuminuria). All AA selected controls had normoalbuminuria (group IV). RESULTS: In normoalbuminuric patients, the average of blood pressure was significantly lower in patients with sickle cell disease than in controls (respectively 115.0 +/- 8.1 vs 132.1 +/- 15.1, p = 4.10(-6) for systolic pressure and 67.2 +/- 8.0 vs 78.8 +/- 9.8 mmHg, p = 10(-4) for diastolic pressure). There was a positive relation between urinary albumin excretion, even moderate (values < or = 300 mg daily) and blood pressure in SS patients (r = 0.40, p < 0.02 for systolic and r = 0.54, p < 0.01 for diastolic pressure) and in SC patients (r = 0.74, p < 0.001 and r = 0.58, p < 0.01). The prevalence of hypertension was 0% in group I, 25% in group II and 66% in group III. CONCLUSION: The positive association between blood pressure and urinary albumin excretion suggests that the latter should be taken into account in sickle cell disease's follow up.