Abstract：
A growing body of research is categorizing sex differences in both sickle cell anemia (SCA) and acute kidney injury (AKI); however, most of this work is being conducted in high-resource settings. Here, we evaluated risk factors and clinical parameters associated with AKI and AKI severity, stratified by sex, in a cohort of children hospitalized with SCA and vaso-occlusive pain crisis (VOC). The purpose of this study was to explore sex disparities in a high-risk, vulnerable population. This study was a secondary analysis of data collected from a cohort of Ugandan children between 2 and 18 yr of age prospectively enrolled. A total of 185 children were enrolled in the primary study; 41.6% were female and 58.4% were male, with a median age of 8.9 yr. Incident or worsening AKI (P = 0.026) occurred more frequently in female compared with male children, despite no differences in AKI on admission. Female children also had altered markers of renal function including higher creatinine levels at admission (P = 0.03), higher peak creatinine (P = 0.006), and higher urine neutrophil gelatinase-associated lipocalin (NGAL) at admission (P = 0.003) compared with male children. Female children had elevated total (P = 0.045) and conjugated bilirubin at admission (P = 0.02) compared with male children and higher rates of hematuria at admission (P = 0.004). Here, we report sex differences in AKI in children with SCA and VOC, including increased incidence and worsening of AKI in female pediatric patients, in association with an increase in biological indicators of poor renal function including creatinine, estimated glomerular filtration rate, and NGAL.NEW & NOTEWORTHY In this study, we report an increased risk of developing acute kidney injury (AKI) during hospitalization, worsening AKI, and death among females with sickle cell anemia (SCA) hospitalized with an acute pain crisis compared with males. The sex differences in AKI were not explained by socioeconomic differences, severity of pain, or disease severity among females compared with males. Together, these data suggest that female children with SCA may be at increased risk of AKI.
摘要：
越来越多的研究正在对镰状细胞性贫血（SCA）和急性肾损伤（AKI）的性别差异进行分类。然而,大部分工作是在高资源环境中进行的。这里,我们评估与AKI和AKI严重程度相关的危险因素和临床参数，按性别分层，在一组因SCA和血管闭塞性疼痛危象（VOC）住院的儿童中。这项研究的目的是探讨高危人群中的性别差异，弱势群体。这项研究是对从2至18岁的乌干达儿童队列中收集的数据的二次分析。共有185名儿童参加了初步研究，41.6%为女性,58.4%为男性,平均年龄8.9岁。与男性儿童相比，女性儿童的AKI事件或恶化（p=0.026）发生率更高，尽管AKI在入院时没有差异。女性儿童也有肾功能指标的改变，包括入院时肌酐水平较高（p=0.03），和更高的峰值肌酐（p=0.006）;与男性儿童相比，入院时尿液NGAL更高（p=0.003）。与男性儿童相比，女性儿童在入院时的总胆红素（p=0.045）和结合胆红素（p=0.02）升高，入院时血尿发生率较高（p=0.004）。在这里，我们报告了SCA和VOC儿童AKI的性别差异，包括女性儿科患者AKI的发病率增加和恶化，与包括肌酐在内的肾功能不良的生物学指标增加有关，估计肾小球滤过率(eGFR)，和NGAL。
