Emerging Therapies and Advances in Sickle Cell Disease with a Focus on Renal Manifestations

Abstract

The underlying mechanisms of disease in sickle cell disease (SCD) contribute to a multifaceted nephropathy, commonly manifested as albuminuria. In severe SCD genotypes ( e.g. , Hemoglobin SS [HbSS]), albuminuria and CKD are major predictors of mortality in this population. Therefore, the monitoring and management of renal function is an intrinsic part of comprehensive care in SCD. Management of nephropathy in SCD can be accomplished with SCD-directed therapies and/or CKD-directed therapies. In the past 5 years, novel disease-modifying and palliative therapies have been approved in SCD to target aspects of the disease, such as anemia, inflammation, and vasculopathy. Along with conventional hydroxyurea and chronic transfusion, l -glutamine, crizanlizumab, and voxelotor have all been shown to mitigate some adverse effect of SCD, and their effect on nephropathy is being investigated. CKD-directed therapies such as renin-angiotensin-aldosterone system blockers have long been used in SCD nephropathy; however, more complete long-term studies on benefits are needed. Given the effect of renal disease on survival, further assessment of the mechanisms and efficacy of these SCD-directed or CKD-directed therapeutic agents is essential.

Trial registration: ClinicalTrials.gov NCT04053764 NCT03814746 NCT04335721 NCT05431088 NCT02712346 NCT04573920 NCT03493685 NCT03762850 NCT05031780 NCT04624659.

Figure 1

Clinical manifestation of SCA by region of the kidneys. SCA, sickle cell anemia.

Figure 2

Schematic demonstrating the major mechanisms of SCA on vasculopathy and point of effect of targeted therapeutics. Cr, crizanlizumab; HU, hydroxyurea; L-g, l-glutamine; SCA, sickle cell anemia; Vx, voxelotor.