**5. Current treatment**

The treatment of renal complication in SCD patients should include an adequate fluid intake in order to avoid dehydration due to hyposthenuria. The chronic use of drugs toxic to the kidneys, such as non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided due to the potential for adverse hemodynamic-related renal function deterioration, precipitation of papillary necrosis, and the development of NSAID-associated interstitial nephritis and glomerulonephropathies.

#### **5.1. Treatment of hematuria**

Hematuria in SCD is typically self-limited. Patients with hematuria should be advised to maintain a high urine output by oral hydration and remain at rest. However, in cases of massive hematuria, a high urine output should be maintained with combination of isotonic fluids and loop diuretics, and adopt measures to alkalinize urine, with sodium bicarbonate or acetazolamide. These measures modify the acid and hypertonic environment of the medullar region, which favors erythrocyte dehydration, HbS concentration and its polymerization [80]. Patients are advised to maintain a urinary volume of 2–4 L/day. Also blood transfusion may be necessary in order to reduce HbS level and sickling [146].

In cases of refractory hematuria, high doses of oral urea may be required to achieve blood urea nitrogen levels greater than 100 mg/dL, or treatment with vasopressin or epsilon-aminocaproic acid (EACA) to promote clotting [147].
