The Connection Between Anemia and Chronic Kidney Disease
This article explores the connection between anemia and chronic kidney disease to help patients find the proper diagnosis and treatment for their symptoms. When a patient has CKD, anemia may be part of the picture. Here's what to watch for and the steps you'll need to take. Washington): The association of anemia with renal failure was first documented by Richard Bright more than years ago. The nature of this anemia was.
The clinical evaluation of the patient is key in working up the anemia.
- Anemia in Chronic Kidney Disease
Clues in the history include: Evidence suggestive of reduced iron and vitamin intake "tea-and-toast" diet Evidence for blood loss for example, history of vomiting coffee ground like material, rectal bleeding Underlying history suggesting an inflammatory focus for example, a failed allograft, a skin ulcer in a diabetic patient, sacral sore in an elderly, bed-ridden patient, or an active autoimmune process like rheumatoid arthritis.
The physical examination can also provide important clues.
For example, patients with an iron deficiency may chew or suck ice pagophagia. Occasionally, they may complain of dysphasia, brittle fingernails, relative impotence, fatigue, and cramps in the calves on climbing stairs out of proportion to their anemia. In vitamin B deficiency, early graying of the hair, a burning sensation in the tongue, and a loss of proprioception are common.
Patients with folate deficiency may have a sore tongue, cheilosis, and symptoms associated with steatorrhea. Color, bulk, frequency, and odor of stools and whether the feces float or sink can be helpful in detecting malabsorption. The differential diagnosis of anemia of CKD is long and includes: What tests should be performed? A complete blood count CBC: Absolute reticulocyte count to assess the hematological response to the anemia.
Anemia of Chronic Kidney Disease - Renal and Urology News
Measures of iron stores: Other considerations in the anemia work-up include: If GI bleeding is suspected then endoscopy and radiographic studies should be considered in order to identify the bleeding site. However, the source of GI bleeding may be from an angiodysplastic lesion, which is more common in CKD patients and may be very difficult to detect.
GI bleeding also may be exacerbated by the effect of uremia on platelet function, where it can prolong the bleeding time. Bone marrow aspirates and biopsy findings are particularly useful in establishing the etiology of anemia in patients with decreased production of red blood cells RBCs. A bone marrow biopsy will help in the work of various hematological problems including aplasia, megaloblastic hyperplasia, infiltration of marrow with neoplasia, myelodysplasia, and myelofibrosis.Stages of Kidney Disease
In addition, a bone marrow biopsy may be useful in the diagnosis of leukemias, lymphomas, myelomas, and metastatic carcinomas. Assessment of Iron deficiency. A health care provider diagnoses anemia based on a medical history blood tests Medical History Taking a medical history is one of the first things a health care provider may do to diagnose anemia.
Physical Exam A physical exam may help diagnose anemia. Blood Tests To diagnose anemia, a health care provider may order a complete blood count, which measures the type and number of blood cells in the body. Two other blood tests help measure iron levels: The ferritin level helps assess the amount of iron stored in the body.
Anemia of Chronic Kidney Disease
A ferritin score below nanograms ng per milliliter may mean a person has iron deficiency that requires treatment. A transferrin saturation score below 30 percent can also mean low iron levels that require treatment. How is anemia in chronic kidney disease treated? Depending on the cause, a health care provider treats anemia with one or more of the following treatments: Iron The first step in treating anemia is raising low iron levels.
Iron pills may help improve iron and hemoglobin levels. However, for patients on hemodialysis, many studies show pills do not work as well as iron given intravenously. A health care provider, often a nurse, injects the patient with EPO subcutaneously, or under the skin, as needed.
Some patients learn how to inject the EPO themselves. Patients on hemodialysis may receive EPO intravenously during hemodialysis.