Artículo
Sickle cell disease and kidney disease
Learn how sickle cell disease can affect your kidneys, the risks to watch for, and the steps you can take to stay healthy through early testing and treatment.
- Revisión médica de
- AKF's Medical Advisory Committee
- Última actualización
- January 23, 2026
What is sickle cell anemia?
Sickle cell anemia is a genetic blood disorder that affects hemoglobin, the part of your red blood cells that carries oxygen through your body. With sickle cell anemia, red blood cells, which are usually round and flexible, become hard, sticky and shaped like a "C," which makes it harder for blood to flow, lowering the amount of oxygen that gets to your organs. Many people with sickle cell disease have ongoing anemia and need blood transfusions to replace damaged cells with healthy ones. Pain is the most common sign of the disease. It can feel like sharp, throbbing or aching sensations deep in the bones, muscles and joints.
How does sickle cell anemia affect the kidneys?
Sickle cell nephropathy occurs when sickle cell anemia begins to affect the kidneys. When your kidneys don't get enough oxygen, kidney tissue can become damaged. When the kidneys are damaged, they can't filter waste and extra fluid from the blood as well as they should. Over time this damage may lead to chronic kidney disease (CKD) or kidney failure. People with sickle cell anemia are also more likely to develop hematuria (blood in the urine) and proteinuria (protein in the urine). Both are signs that the kidneys are under stress or getting damaged.
About 20-25% of people with sickle cell disease develop CKD.
What causes it: Sickle cell disease vs. sickle cell trait
A person has sickle cell disease (SCD) when they inherit a sickle cell gene from each parent, meaning it is a recessive condition.
A person has sickle cell trait (SCT) when they inherit one sickle cell gene and one normal gene, making them a carrier. Most people with SCT do not have symptoms, but they are at a higher risk of developing CKD.
Sickle cell trait and kidney cancer
New research shows that sickle cell trait is not as harmless as doctors once believed. People with the trait have a higher risk of CKD than those without it. It can also cause a rare type of kidney cancer called renal medullary carcinoma (RMC). RMC mostly affects teenagers and young adults and is usually only seen in people with sickle cell trait.
RNC symptoms include:
- Blood in your pee (usually the first symptom)
- A lump or mass where your kidneys are (your lower back, just below your ribcage)
- Pain where the affected kidney is (for most people, it's the kidney on the right side)
- Fever
- Night sweats
- Unexplained weight loss
Who is at risk for sickle cell anemia?
Sickle cell anemia is more common in certain ethic groups, including:
- People of African or African American descent
- People with Caribbean, Central American or South American ancestry
- People with Middle Eastern, Mediterranean or South Asian ancestry
Anyone can carry the sickle cell gene, but it is most often found in these communities. A simple blood test can show whether someone carries the gene or has sickle cell anemia.
- 1 in 12 Black Americans carry a sickle cell gene
- 9 out of 10 people with sickle cell anemia are Black American
What are the symptoms of sickle cell nephropathy?
Symptoms of sickle cell kidney disease may be hard to detect early. Overtime, symptoms can become more noticeable as kidney damage progresses.
Symptoms of sickle cell kidney disease can include:
- Pain: You may feel pain in the side, back, where the kidneys are located.
- Frequent urination
- Hematuria: Sometimes urine may look red or brown, or tea colored.
- High blood pressure: People with sickle cell disease often have lower blood pressure than average, so high blood pressure can be a warning sign of sickle cell kidney disease.
- Proteinuria: Protein in the urine is a common sign of kidney damage.
Sickle cell kidney disease can have symptoms that happen at the same time as symptoms of sickle cell disease, including:
- Sickle cell crises: severe periods of pain that can last for days or even weeks
- Increased risk of infection
- Anemia or a shortage of red blood cells
- Increased chance of strokesa
How is sickle cell kidney disease diagnosed?
Sickle cell anemia symptoms can start at any age, but infants usually start going signs at 5 or 6 months old. Many people do not notice early kidney damage, so regular testing is important even when there are no symptoms. Doctors look for signs that sickled red blood cells are affecting blood flow to the kidneys or causing damage over time. Blood and urine tests are the main tools used to check how well the kidneys are working.
Kidney function tests used to check for sickle cell nephropathy include:
- eGFR test (estimated glomerular filtration rate) to measure how well the kidneys filter waste
- Urine albumin-to-creatinine ratio (uACR) to check for protein in the urine
- Serum creatinine to look for creatinine or waste buildup in the blood
- Electrolyte level tests to check important minerals in your blood, like sodium, potassium, calcium and magnesium. These levels can become too high or too low when the kidneys are not working well.
- Urinalysis to look for blood or other early signs of kidney injury in the urine
Your doctor may also use imaging tests or a kidney ultrasound to look at kidney size and structure. In some cases, a kidney biopsy is needed to understand the exact type of kidney damage.
How is sickle cell kidney disease treated?
Treating kidney disease caused by sickle cell anemia involves protecting the kidneys from further damage and managing any complications. Treatment often includes medicines and lifestyle changes.
Treatments for sickle cell disease and kidney support
Certain medicines used to treat sickle cell disease (SCD) also help protect the kidneys:
- Hydroxyurea: This medicine helps your body make a different kind of hemoglobin that is less likely to cause sickling (red blood cells having a "C" shape).
- ACE inhibitors: Help control blood pressure and manage kidney function. Blood pressure should be checked often, even at home.
- Blood transfusions: Transfusions provide the body with healthy red blood cells. For patients at high risk of kidney damage, regular transfusions may be used to reduce sickling and improve oxygen delivery to the kidneys.
- Your doctor may also prescribe medicines and therapies to ease the bone and joint pain that can happen with sickle cell anemia.
Other recommendations
- Drinking water: Staying hydrated throughout the day helps blood flow more easily and prevents red blood cells from sickling.When you don't drink enough, your blood can get thicker, which makes it easier for sickle-shaped cells to block blood flow.
- Nutrition: A registered dietitian can help create a nutrition plan that supports higher calorie and protein needs common in sickle cell disease, while protecting kidney health.
- During illness or hot weather: You need to be extra careful to drink plenty of fluids when you are sick, during hot weather or during heavy exercise. Dehydration makes the blood more concentrated and increases the risk of sickling and blood vessel blockages in the kidneys.
- Managing anemia: Certain vitamins like folic acid help the body make healthy red blood cells. For people with low red blood cell levels, these treatments can lower the chance of sickling.
How to live well with sickle cell anemia and kidney disease
Living well with sickle cell anemia and kidney disease means staying engaged in your care and working closely with your health team. Small steps can make a big difference in slowing kidney damage and preventing complications.
Stay on top of lab tests and appointments
Regular testing helps your care team track changes and catch problems early.
Keeping appointments on schedule gives your team the information they need to adjust treatment.
Work with the right specialists
- See a nephrologist (kidney doctor) who has experience caring for people with sickle cell disease.
- Stay connected with your hematologist (a doctor who specializes in blood disorders), who manages your sickle cell care.
Prevent infections and manage pain
- Stay up to date on vaccines.
- Recognize early signs of infection, like fever, burning with urination or sudden fatigue.
- Work with your care team on a safe pain plan that protects your kidneys.
Build healthy routines
- Hydration: Drink water throughout the day to help blood flow smoothly and protect the kidneys.
- Nutrition: Follow a personalized eating pattern that supports your kidney function and overall health.
- Activity: Aim for regular exercise that feels comfortable and safe for your body.
- Avoid triggers: Extreme heat or cold, dehydration, stress and illness can worsen symptoms.
Without regular care, sickle cell-related kidney problems can progress to kidney failure. If kidney failure develops, treatment options include dialysis or transplant. Many people with sickle cell disease do well with a kidney transplant when it is carefully coordinated by their care team. Taking these steps helps protect your kidneys, reduce complications and support a healthier, more active life with sickle cell disease.