The Case | Microhematuria in a patient with beta-thalassemia major: a casual or a causal association?

Abstract

A 42-year-old woman, with transfusion-dependent thalassemia major (CD39/CD39) since 1 year of age, seeks nephrological attention for microhematuria. Her medical history includes most of the long-term problems known to occur in long-standing beta-thalassemia: she is HCV positive (genotype 1b), with HCV-related chronic liver disease with type III cryoglobulinemia and arthritis (treated with steroids and cyclosporine A, and later switched to methotrexate); she also developed steroid-induced diabetes and hypogonadism because of iron overload, and thalassemia-related osteoporosis (moderate-severe reduction of the bone density) with a possible steroid-related component; she underwent splenectomy at the age of 17 years. She complained of two episodes of renal colic in the past 5 years without stone passing.

Revisiting nephrocalcinosis: A single‐centre perspective. A northern Italian experience

“…Of note, three patients had concomitant immunological diseases and three had a history of urinary tract infections or AKI, thus stressing the clinical importance of the biochemical and imaging data (Table ). The exact pathogenesis of nephrocalcinosis and hypercalciuria in thalassaemic patients is not yet known: it has been reported more often in adults than in children, with different levels of iron load, and seems to be unrelated to the type of iron chelation or to the intensity of blood transfusions, but may correlate with the age of the patients (and to the duration of the disease) …”