Indoxil sulfato urinário (Indican) em crianças e adolescentes com doença falciforme: avaliação de disbiose intestinal e fatores associados

Abstract

Introduction: Urinary indoxyl sulfate (Indican) is an organic acid derived from the amino acid tryptophan from diet that is metabolised by intestinal bacteria through tryptophanases. Indican is present in low urine in healthy individuals and a high level of urinary indican is an indication of bacterial overgrowth in the small intestine. Sickle cell disease (SCD) is one of the most prevalent genetic diseases worldwide. It is an autosomal recessive disorder, with acute vaso-occlusive crisis being its most common manifestation. Intestinal dysbiosis is defined as intestinal microbiota (IM) imbalance and may be present in SCD. Objective: To verify the occurrence of intestinal dysbiosis in patients with SCD, with and without hydroxyurea. Methods: This is a sectional study conducted between January 2018 and March 2019, involving 98 children and adolescents (05 to 18 years), divided into three groups: G1. SCD patients with hydroxyurea; G2 SCD patients without hydroxyurea; G3 control (individuals without SCD). Urine examination (Indican) was performed to assess intestinal dysbiosis, parasitological stool, anthropometric indices, Rome IV criteria, Bristol stool scale, and socioeconomic and demographic status. Results: It was found the presence of intestinal dysbiosis among the participants, being 74% in G1, 76% in G2 and 65% in G3. Variables such as type of delivery, time of breastfeeding and functional constipation were associated with Indican concentrations, regardless of the presence of the SCD between the groups. Conclusion: High urinary Indican concentrations were observed in patients with SCD, as well as in the control group, indicating intestinal dysbiosis, with no significant difference.