Anemia of Chronic Kidney Disease

Question 1

To have chronic renal disease, patients must have diminished glomerular filtration rate for _ months

Answer 1

To have chronic renal disease, patients must have diminished glomerular filtration rate, or persistent albuminuria for 3 months

Question 2

Common causes of chronic renal disease:

Answer 2

• Diabetes mellitus
• Hypertension
• Glomerular disease

Question 3

The important hormone that the kidney secretes that makes it relevant to anemia is _

Answer 3

The important hormone that the kidney secretes that makes it relevant to anemia is erythropoietin (EPO)

Question 4

EPO acts on _ receptors in the bone marrow and stimulates the _

Answer 4

EPO acts on JAK/STAT receptors in the bone marrow and stimulates the release of reticulocytes

Question 5

EPO also binds to _ on immature RBCs and stimulates the maturation of RBCs

Answer 5

EPO also binds to erythropoietin receptors on immature RBCs and stimulates the maturation of RBCs

Question 6

EPO made in the kidney is specifically made by cells near the _

Answer 6

EPO made in the kidney is specifically made by cells near the peritubular capillary bed
* Interstitial cells in the peritubular capillary bed are damaged during chronic kidney disease which is why we can’t make sufficient EPO
* Interstitial cells can no longer respond to hypoxia and hypoxia inducible factors (HIFs) –> insufficient EPO –> anemia

Question 7

Chronic renal disease can lead to shortened RBC survival as well as true iron deficiency from _

Answer 7

Chronic renal disease can lead to shortened RBC survival as well as true iron deficiency from uremia-induced platelet dysfunction
* Uremia: build up of urea and creatine waste products in the blood
* This impairs platelet adhesion and aggregation
* We get ineffective blood clotting and blood/iron loss

Question 8

On top of the decreased RBC lifespan and the true iron deficiency we can also get a functional iron deficiency from chromic renal disease; explain

Answer 8

Chronic inflammatory state –> liver produces acute phase reactants including hepcidin –> traps iron in the macrophages and decreases iron absorption from enterocytes by down-regulating ferroportin

Question 9

During end-stage renal disease we may see _ cells on blood smear

Answer 9

During end-stage renal disease we may see echinocytes (burr cells) on blood smear

Question 10

To treat anemia of chronic kidney disease we may give _ or _

Answer 10

To treat anemia of chronic kidney disease we may give erythropoiesis-stimulating agents or iron supplementation