Renal Findings in Patients with Thalassemia at Abdominal Ultrasound: Should We Still Talk about “Incidentalomas”? Results of a Long-Term Follow-Up
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Data Collection
2.2. Assessment of Renal Stones, Cysts, and Tumors
2.3. Laboratory Investigations
2.4. Iron Overload Assessment
2.5. Statistical Analysis
3. Results
3.1. Study Population
3.2. Renal Stones
3.2.1. Development of Renal Stones
3.2.2. Comparison of Baseline Data between Patients without and with Renal Stones
3.2.3. Prediction of Renal Stones
3.3. Renal Cysts
3.3.1. Development of Renal Cysts
3.3.2. Comparison of Baseline Data between Patients without and with Renal Cysts
3.3.3. Prediction of Renal Cysts
3.3.4. Evolution of Renal Cysts
- –
- Twenty-six (65.0%) patients: no change in cyst size or grading and no newly developed cysts;
- –
- Six (15.0%) patients: increase in cyst size and no newly developed cysts;
- –
- Two (5.0%) patients: increase in cyst size and grading (from Bosniak I to Bosniak III for one patient and from Bosniak I to Bosniak II for the other patient) and no newly developed cysts;
- –
- Three (7.5%) patients: increase in cyst size and newly developed cysts;
- –
- Two (5.0%) patients: increase in cyst grading (from Bosniak I to Bosniak II) and newly developed cysts;
- –
- One (2.5%) patient: increase in cyst size and grading (from Bosniak I to Boniak II) and newly developed cysts.
3.4. Renal-Cell Carcinoma
3.4.1. RCC: Prevalence and Incidence
3.4.2. Characteristics of Patients Diagnosed with RCC
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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All Patients (N = 231) | No Renal Stones (N = 196) | Renal Stones (N = 35) | p-Value | |
---|---|---|---|---|
Female sex, N (%) | 132 (57.1) | 112 (57.1) | 20 (57.1) | 1.000 |
Age (years) | 36.18 ± 13.84 | 35.67 ± 14.31 | 39.03 ± 10.53 | 0.215 |
TM, N (%) | 112 (48.5) | 88 (44.9) | 24 (68.6) | 0.010 |
Annual blood consumption (mg/k die) | 0.25 ± 0.53 | 0.19 ± 0.19 | 0.51 ± 1.24 | 0.005 |
Splenectomy, N (%) | 95 (41.1) | 73 (37.2) | 22 (62.9) | 0.005 |
Active or past HCV infection, N (%) | 99 (42.9) | 81 (41.3) | 18 (51.4) | 0.266 |
Hypertension, N (%) | 16 (6.9) | 14 (7.1) | 2 (5.7) | 0.759 |
Diabetes, N (%) | 8 (3.5) | 6 (3.1) | 2 (5.7) | 0.348 |
Body mass index (kg/m2) | 23.19 ± 3.67 | 23.15 ± 3.81 | 23.45 ± 2.81 | 0.649 |
Serum ferritin (ng/mL) | 1178.61 ± 1426.83 | 1185.39 ± 1497.15 | 1140.86 ± 959.63 | 0.327 |
Serum hemoglobin (g/dL) | 9.67 ± 0.86 | 9.68 ± 0.84 | 9.60 ± 0.98 | 0.567 |
Serum transferrin receptor-1 (mg/L) | 5.34 ± 2.95 | 5.51 ± 3.02 | 4.39 ± 2.32 | 0.021 |
Serum creatinine (mg/dL) | 0.69 ± 0.31 | 0.69 ± 0.33 | 0.73 ± 0.15 | 0.014 |
Uric acid (mg/dL) | 4.46 ± 1.27 | 4.45 ± 1.28 | 4.51 ± 1.24 | 0.726 |
Proteinuria (mg/dL) | 17.21 ± 42.70 | 13.42 ± 23.15 | 38.12 ± 92.83 | 0.003 |
MRI LIC (mg/g dw) | 6.01 ± 6.39 | 6.28 ± 6.62 | 5.73 ± 5.12 | 0.328 |
Univariate Analysis | ||
---|---|---|
HR (95% CI) | p-Value | |
Female sex | 0.96 (0.49–1.88) | 0.913 |
Age | 1.02 (0.99–1.04) | 0.137 |
TM | 2.26 (1.11–4.62) | 0.025 |
Annual blood consumption | 2.24 (1.53–3.27) | <0.0001 |
Splenectomy | 2.57 (1.29–5.09) | 0.007 |
Active or past HCV infection | 1.37 (0.71–2.66) | 0.351 |
Hypertension | 0.87 (0.21–3.62) | 0.845 |
Diabetes | 1.73 (0.41–7.19) | 0.453 |
Body mass index | 1.02 (0.93–1.11) | 0.745 |
Serum ferritin | 1.00 (1.00–1.00) | 0.818 |
Serum hemoglobin | 0.89 (0.60–1.32) | 0.566 |
Serum transferrin receptor-1 | 0.86 (0.74–1.00) | 0.055 |
Serum creatinine | 1.33 (0.66–2.68) | 0.420 |
Uric acid | 1.06 (0.82–1.37) | 0.662 |
Proteinuria | 1.01 (1.00–1.01) | 0.004 |
MRI LIC | 0.95 (0.89–1.03) | 0.212 |
All Patients (N = 217) | No Renal Cysts (N = 177) | Renal Cysts (N = 40) | p-Value | |
---|---|---|---|---|
Female sex, N (%) | 127 (58.5) | 101 (57.1) | 26 (65.0) | 0.357 |
Age (years) | 35.17 ± 13.39 | 33.95 ± 13.35 | 40.55 ± 12.39 | 0.006 |
TM, N (%) | 106 (48.8) | 85 (48.0) | 21 (52.5) | 0.609 |
Annual blood consumption (mg/k die) | 0.25 ± 0.54 | 0.21 ± 0.20 | 0.39 ± 1.18 | 0.845 |
Splenectomy, N (%) | 82 (37.8) | 62 (35.0) | 20 (50.0) | 0.078 |
Active or past HCV infection, N (%) | 84 (38.7) | 65 (36.7) | 19 (47.5) | 0.206 |
Hypertension, N (%) | 10 (4.6) | 6 (3.4) | 4 (10.0) | 0.072 |
Diabetes, N (%) | 6 (2.8) | 5 (2.8) | 1 (2.5) | 0.910 |
Body mass index (kg/m2) | 23.03 ± 3.59 | 22.78 ± 3.64 | 24.16 ± 3.19 | 0.011 |
Serum ferritin (ng/mL) | 1175.43 ± 1444.44 | 1225.41 ± 1524.97 | 955.51 ± 1002.96 | 0.741 |
Serum hemoglobin (g/dL) | 9.64 ± 0.89 | 9.65 ± 0.93 | 9.61 ± 0.74 | 0.838 |
Serum transferrin receptor-1 (mg/L) | 5.36 ± 2.91 | 5.38 ± 3.01 | 5.29 ± 2.40 | 0.711 |
Serum creatinine (mg/dL) | 0.69 ± 0.31 | 0.69 ± 0.34 | 0.73 ± 0.18 | 0.034 |
Uric acid (mg/dL) | 4.54 ± 1.28 | 4.55 ± 1.29 | 4.49 ± 1.25 | 0.810 |
Proteinuria (mg/dL) | 17.49 ± 43.89 | 16.55 ± 47.13 | 21.60 ± 25.46 | 0.017 |
MRI LIC (mg/g dw) | 6.28 ± 6.56 | 6.38 ± 6.72 | 5.89 ± 5.98 | 0.661 |
Univariate Analysis | ||
---|---|---|
HR (95% CI) | p-Value | |
Female sex | 1.36 (0.71–2.60) | 0.355 |
Age | 1.04 (1.02–1.07) | 0.001 |
TM | 0.94 (0.50–1.74) | 0.837 |
Annual blood consumption | 1.26 (0.96–1.67) | 0.102 |
Splenectomy | 1.72 (0.92–3.19) | 0.087 |
Active or past HCV infection | 1.46 (0.78–2.71) | 0.235 |
Hypertension | 3.56 (1.26–10.05) | 0.016 |
Diabetes | 0.90 (0.12–6.57) | 0.919 |
Body mass index | 1.09 (1.01–1.18) | 0.031 |
Serum ferritin | 1.00 (1.00–1.00) | 0.287 |
Serum hemoglobin | 0.95 (0.67–1.34) | 0.761 |
Serum transferrin receptor-1 | 1.00 (0.89–1.13) | 0.959 |
Serum creatinine | 1.27 (0.64–2.51) | 0.490 |
Uric acid | 0.98 (0.77–1.24) | 0.844 |
Proteinuria | 1.00 (0.99–1.01) | 0.562 |
MRI LIC | 0.99 (0.93–1.05) | 0.684 |
Pt 1 | Pt 2 | Pt 3 | Pt 4 | Pt 5 | Pt 6 | Pt 7 | Pt 8 | Pt 9 | Pt 10 | |
---|---|---|---|---|---|---|---|---|---|---|
RCC subtype | clear-cell | mucinous tubular and spindle-cell | clear-cell | clear-cell | clear-cell | clear-cell | chromophobe | clear-cell | clear-cell | clear-cell |
RCC staging | T1a NX | T1b N0 | T3b | T2 N1 | not available | T3a | T1 N0 | not available | T1a | not available |
RCC stage group | I | not available | 3 | 2 | 1 | not available | 1 | not available | II | not available |
RCC site | right kidney | right kidney | right kidney | right kidney | right kidney | right kidney | right kidney | right kidney | left kidney | left kidney |
Canceration of a previous renal cyst | no | yes | yes | no | no | no | no | no | no | yes |
Symptoms | no | no | no | no | no | no | no | no | no | no |
Co-presence of hepatic cell carcinoma | yes | no | no | no | no | yes | no | no | no | no |
Disease | TI regularly transfused | TI non-transfused | TM | TM | TM | TM | TM | TM | TM | TM |
Genotype (Phenotype) | CD39/IVS-1,6 (β0 β+) | CD39/IVS-1,6 (β0 β+) | IVS-1,6/IVS-1,110 (β+ β+) | CD39/IVS-1,6 (β0 β+) | IVS-1,110/IVS-1,110 (β+ β+) | CD39/IVS-1,1 (β0 β0) | IVS-1,6/IVS-1,6 (β+ β+) | CD6/IVS-2,1 (β0 β0) | IVS-1,1/IVS-1,1 (β0 β0) | CD39/IVS-1,110 (β0 β0) |
Sex | female | female | female | male | female | male | female | male | female | male |
Age at diagnosis (years) | 60.4 | 54.3 | 39.0 | 44.6 | 53.1 | 44.9 | 53.9 | 50.7 | 41.5 | 42.0 |
Splenectomy | yes | yes | yes | yes | yes | no | yes | yes | yes | yes |
Anti-HCV | positive | positive | positive | positive | positive | positive | positive | positive | positive | positive |
HCV RNA | negativized after antiviral therapy | negative | negative | positive | negativized after antiviral therapy | negative | negativized after antiviral therapy | negative | negativized after antiviral therapy | negative |
Smoking | never | never | never | never | never | never | never | yes | yes | never |
Serum ferritin (ng/mL) | 396.0 | 519.0 | 180.0 | 4020.0 | 1283.0 | 419.0 | 750.0 | 3800.0 | 803.0 | 250.0 |
Serum hemoglobin (g/dL) | 10.8 | 8.6 | 9.5 | 10.3 | 8.8 | 9.5 | 10.4 | 9.7 | 9.8 | 10.5 |
Serum transferrin receptor-1 (mg/L) | 3.8 | 8.3 | not available | 3.4 | 2.3 | 7.0 | 4.5 | 5.2 | 3.0 | 2.8 |
Serum creatinine (mg/dL) | 0.7 | 0.6 | not available | 1.1 | 0.8 | 0.6 | 0.5 | 0.5 | 0.6 | 0.8 |
Uric acid (mg/dL) | 3.0 | 6.4 | not available | 6.6 | 4.4 | 6.0 | 4.1 | 5.0 | 3.5 | 3.8 |
Proteinuria (mg/dL) | 0.0 | 12.4 | not available | 7.8 | 7.7 | 8.5 | 0.0 | 0.0 | 22.2 | 35.9 |
MRI LIC (mg/g dw) | 1.9 | 8.3 | not available | 4.9 | 9.9 | 3.3 | 1.1 | 11.3 | 5.9 | 14.8 |
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© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Fatigati, C.; Meloni, A.; Costantini, S.; Spasiano, A.; Ascione, F.; Cademartiri, F.; Ricchi, P. Renal Findings in Patients with Thalassemia at Abdominal Ultrasound: Should We Still Talk about “Incidentalomas”? Results of a Long-Term Follow-Up. Diagnostics 2024, 14, 2047. https://doi.org/10.3390/diagnostics14182047
Fatigati C, Meloni A, Costantini S, Spasiano A, Ascione F, Cademartiri F, Ricchi P. Renal Findings in Patients with Thalassemia at Abdominal Ultrasound: Should We Still Talk about “Incidentalomas”? Results of a Long-Term Follow-Up. Diagnostics. 2024; 14(18):2047. https://doi.org/10.3390/diagnostics14182047
Chicago/Turabian StyleFatigati, Carmina, Antonella Meloni, Silvia Costantini, Anna Spasiano, Flora Ascione, Filippo Cademartiri, and Paolo Ricchi. 2024. "Renal Findings in Patients with Thalassemia at Abdominal Ultrasound: Should We Still Talk about “Incidentalomas”? Results of a Long-Term Follow-Up" Diagnostics 14, no. 18: 2047. https://doi.org/10.3390/diagnostics14182047
APA StyleFatigati, C., Meloni, A., Costantini, S., Spasiano, A., Ascione, F., Cademartiri, F., & Ricchi, P. (2024). Renal Findings in Patients with Thalassemia at Abdominal Ultrasound: Should We Still Talk about “Incidentalomas”? Results of a Long-Term Follow-Up. Diagnostics, 14(18), 2047. https://doi.org/10.3390/diagnostics14182047