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Kidney, eye and joint complications in sickle cell disease | CION Cancer Clinics
Sickle cell can damage the kidneys, the retina at the back of the eye and the hip bone, because sickled cells block the tiny vessels feeding them. Most of this is silent for years. A urine test, blood pressure, kidney blood tests, a dilated eye examination and a scan for lasting joint pain find it early, when treatment protects the organ most. This page explains the signs and the checks. At CION Cancer Clinics, our haematologist cares for anaemia, bleeding, clotting and inherited blood disorders, with ArogyaSri, CGHS and cashless insurance accepted.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- Why does sickle cell affect the kidneys, eyes and hips?
- What can go wrong, and what do you notice?
- Which checks should you ask your haematologist about?
- What do the words on the report mean?
- What do families often get wrong about these problems?
- What can be done, and what can this page not tell you?
- Common questions about kidney, eye and hip problems in sickle cell
The short answer
Why does sickle cell affect the kidneys, eyes and hips?
Sickle cell damages the kidneys, the back of the eye and the hip bones because all three depend on tiny blood vessels that sickled cells block. Most of this damage builds quietly over years, so regular checks find it long before you feel anything.
What is happening inside the body
Healthy red cells are soft and round. Sickled cells are stiff and bent. They stick in narrow vessels and cut off oxygen to the tissue beyond. Small, painless blockages over years slowly wear down an organ.
Why these three in particular
The inner part of the kidney has very little oxygen to begin with, so cells sickle there easily. The retina, the seeing layer at the back of the eye, is fed by vessels as thin as a hair. The top of the thigh bone has a small blood supply with no backup route. When those vessels close, the tissue has nowhere else to get blood from.
Who is more likely to be affected
Kidney and hip problems are more common in people with the severe forms of sickle cell, and they become more likely with age. Eye damage is, oddly, often more common in the milder HbSC type. Your own type is written on your confirmatory test report. Being told you have a mild form is not a reason to skip eye checks.
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Signs that need care the same day
Sudden loss of vision in one eye, a shower of new floaters or a dark curtain across your sight needs an eye emergency department today. So does passing a lot of blood in the urine, or severe hip or back pain with a fever. If the person is very unwell, breathless or confused, call 108 or go to the nearest emergency department. Say they have sickle cell disease. Do not wait for a routine appointment.
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What can go wrong, and what do you notice?
Early changes in all three are silent. The signs below are what you may notice once a problem has grown.
Kidneys
The kidney loses its ability to hold on to water, so urine stays dilute and you dehydrate faster. Later, protein leaks into the urine and filtering slowly falls.
What you may notice
- Bedwetting in an older child
- Passing large amounts of urine, feeling thirsty
- Blood in the urine
- Puffy ankles or face, frothy urine
Eyes
Blocked vessels in the retina make the eye grow fragile new vessels. These can bleed into the eye or pull the retina away from the back of the eye.
What you may notice
- Usually nothing at all, early on
- New floaters or flashes of light
- Blurred or patchy vision
Hips and shoulders
Avascular necrosis means part of the bone dies because its blood supply was cut off. The ball of the hip joint can then flatten and wear the joint.
What you may notice
- A deep ache in the groin, buttock or thigh
- Pain on walking that eases with rest
- A limp, or stiffness putting on shoes
Regular checks
Which checks should you ask your haematologist about?
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A urine test for protein
A simple urine sample can show small amounts of protein long before the kidney is in trouble. Keep the results together so a rise can be seen.
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Blood pressure at every visit
People with sickle cell often run lower blood pressure than others. A reading that looks normal on a general chart may be high for you, so the trend matters more than one reading.
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A blood test for kidney function
Creatinine and eGFR show how well the kidneys filter. Your team reads them alongside your urine test and past results.
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A dilated eye examination
Drops widen the pupil so an eye specialist can see the edges of the retina, where sickle damage starts. Ask your haematologist how often you need it.
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An X-ray or MRI for hip or shoulder pain
Pain that keeps coming back in the same joint, outside a crisis, should be checked. An MRI can show early bone damage that a plain X-ray misses.
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On your report
What do the words on the report mean?
- Albuminuria or proteinuria
- Protein leaking into the urine. It is often the first sign that the kidney filters are under strain.
- Creatinine and eGFR
- A waste product in the blood, and an estimate of how well the kidneys clear it. Reference ranges differ between laboratories.
- Proliferative sickle retinopathy
- New, fragile blood vessels growing in the retina because older ones were blocked. They can bleed.
- Avascular necrosis or osteonecrosis
- Bone that has died because its blood supply was cut off. Most often seen in the hip, sometimes the shoulder.
Commonly believed
What do families often get wrong about these problems?
"No pain means no damage."
Kidney and eye damage from sickle cell is silent in its early stages. By the time vision blurs or ankles puff up, the change has often been growing for a long while.
"Bedwetting in a school-age child is just a habit."
In a child with sickle cell, it is often the kidney failing to hold on to water. Tell the haematologist, and make sure the child drinks enough through the day, including at school.
"His eyes are fine. He reads without glasses."
Sharp reading vision says nothing about the edges of the retina, where sickle damage begins. Only a dilated examination by an eye specialist can see that area.
"Hip pain is part of sickle cell. You live with it."
Pain in one hip that keeps returning, especially when walking, may be avascular necrosis. Caught early, physiotherapy and other steps can protect the joint for longer. Left alone, the bone can collapse.
Being straight with you
What can be done, and what can this page not tell you?
Each of these problems has treatment, and treatment works better early. The aim is to slow the damage and protect what is still working.
For the kidneys
If protein is leaking, a blood pressure medicine that also protects the kidney may be used. Your team will review which painkillers are safe for your kidneys, since some common ones bought from a chemist can add strain. Do not start or stop any medicine on your own. Ask first.
For the eyes and hips
An eye specialist may use laser treatment to seal off fragile vessels, or surgery if there is bleeding or a pulled retina. For the hip, early steps include taking load off the joint, physiotherapy and sometimes a procedure to relieve pressure in the bone. A hip replacement is considered when the joint has collapsed. It does not suit everyone: general health, age and infection risk all count, and your haematologist plans blood care around any operation.
What this page cannot tell you
It cannot tell you whether you will develop any of these, or how fast. Whether hydroxyurea or regular transfusion protects these organs is still being studied, and the answer differs between people. A single test result means little on its own. Your haematologist reads it against your past results and how you feel.
Questions we are asked
Common questions about kidney, eye and hip problems in sickle cell
Can sickle cell disease cause kidney failure?
It can, but it usually takes a long time and it does not happen to everyone. Most people first show small amounts of protein in the urine. Finding that early lets your team protect the kidney with blood pressure control and careful choice of painkillers. Regular urine and blood tests are how you stay ahead of it.
Why does my child with sickle cell still wet the bed?
Sickle cell often stops the kidney from concentrating urine, so the body makes more of it, including at night. It is not laziness or a behaviour problem. Mention it to your haematologist. Do not cut back on water in the evening without asking, because being short of water can itself trigger a crisis.
My child's vision is perfect. Do they still need an eye check?
Yes, when your haematologist says it is due. Early sickle damage sits at the outer edge of the retina, away from the part used for reading. The child sees normally while it grows. A dilated eye examination by an eye specialist is the only way to find it before it affects sight.
Is laser treatment for the eye safe?
Laser is a common, well-established way to seal fragile new vessels in the retina and lower the chance of bleeding. It carries some risk and is not needed for every change. The eye specialist will explain why it is or is not advised for your eye.
How do I know if hip pain is a crisis or avascular necrosis?
Crisis pain usually comes on suddenly, often in several places, and settles on its own over a short time. Avascular necrosis pain tends to stay in one hip or shoulder, returns with walking or climbing stairs, and slowly worsens. You cannot be sure from symptoms alone. An MRI is the test that tells them apart.
Will I need a hip replacement?
Not necessarily. If bone damage is found before the joint has collapsed, physiotherapy, lighter loading and sometimes a small procedure can delay or avoid replacement. Once the ball of the joint has flattened, replacement may be the most useful option. It needs careful blood planning before surgery, which your haematologist arranges with the surgeon.
Which painkillers are safe for my kidneys?
This depends on your kidney test results and your other medicines, so ask your haematologist rather than a chemist. Some painkillers that are easy to buy can strain kidneys that are already affected by sickle cell. Show your list of medicines at every visit.
Can CION's haematology team arrange these checks?
CION's haematology team reviews your reports, tells you which checks are due and coordinates referrals to kidney, eye and bone specialists at qualified centres. Bring every past urine, blood and eye report you have. Seeing results side by side is often what shows a slow change.
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Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
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Sources
- NHS — Sickle cell disease
- National Heart, Lung, and Blood Institute — Sickle Cell Disease
- American Society of Hematology — Sickle Cell Disease
- National Health Mission, Government of India — National Sickle Cell Anaemia Elimination Mission
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Sickle Cell Disease ExplainedHow sickled cells cause damage in the first placeHydroxyurea in Sickle Cell DiseaseThe medicine often discussed for organ protectionHydration, Heat and Crisis PreventionWhy water matters more when the kidneys leak itWhen a Sickle Cell Crisis Needs HospitalThe signs that mean go nowSickle Cell DiseaseThe full sickle cell guide
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Not sure which checks are due?
Share your urine, blood and eye reports with us. CION's haematology team will review them and help you reach the right specialist. One helpline serves every CION centre.