The Unfinished Story of Sickle Cell Nephropathy: A Narrative Review of Knowledge Gaps and Research Imperatives.

Sickle cell nephropathy (SCN) is one of the most consequential yet under-recognized complications of sickle cell disease (SCD), contributing significantly to long-term morbidity and premature mortality. Despite its clinical importance, SCN often escapes early detection, in part because standard measures of kidney function can mask disease that is already well established. This narrative review synthesizes current evidence on SCN, examining the diagnostic strategies and the evolving therapeutic landscape-with particular attention paid to hydroxyurea, erythropoiesis-stimulating agents, and renal replacement therapy-and identifies the research gaps that must be addressed to improve outcomes for this patient population.