Renal failure anemia

Renal failure anemia: Anemia associated with kidney disease

Renal failure anemia is a common term used to describe the anemia that is associated with kidney diseases. You may have been diagnosed with renal failure anemia by your doctor after your doctor noticed decreased hemoglobin on your regular blood test. But that does not mean that any anemia in a patient with renal failure is renal failure anemia. Doctors try to find other possible causes for the anemia in patients with renal failure before calling it renal failure anemia. The diagnosis of renal failure anemia can be complicated by many other factors that are associated with kidney disease. I will present a few cases that will help you understand how renal failure anemia is diagnoses in real clinical practice. All patient stories presented here are real but the identifying information have been changed to protect the privacy of the patients.

Renal failure anemia: A 38 year old female with polycystic kidney disease

Mrs. K is a 38 year old female. She was diagnosed with polycystic kidney disease when she was pregnant with her only child at the age of 28. She never had any symptom from the kidney disease itself. Her doctors had noticed the cysts in her kidneys when doing her abdominal ultrasound. They were worried that the diagnosis of polycystic kidney disease would increase the risks of the pregnancy but luckily, she had an uneventful child birth and her son is very healthy. She did not know how she go polycystic kidney disease as she was adopted and did not know her biological parents. Normally polycystic kidney disease is passed down from parent to child. There is a 50% chance of transmitting the disease to the offspring.

As she turned 34, doctors noticed she had developed high blood pressure. They checked her kidneys and she seemed to have the beginning stage of kidney failure. Since then, she had regular check ups with her kidney doctors and she is taking medications to try to slow down the deterioration of her kidney function.

One day, she became very sick and had multiple episodes of nausea and vomiting. She was send over to the hospital and I admitted her to the medical floor as I was the on-call doctor. She looked very pale and dehydrated. I started her on iv fluids and obtained some blood work. She was found to have a severe anemia. Her hemoglobin was 8.5. Normal range in female patients of her age is 12 to 15. Her kidney function had also worsened. Her kidneys were only working at about 20% of the normal capacity. I thought about renal failure anemia as she had kidney disease and she had anemia. But the diagnosis of renal failure anemia can not be made until other possible and common causes of anemia have been excluded. As I explained here the most common type of anemia is iron deficiency anemia. We checked a ferritin level in the blood. It came back high. A high ferritin does not rule out Iron deficiency anemia but makes it less likely. We asked he about her menstrual periods and they were normal. She did not have any excess bleeding. We then checked her feces looking for any trace of blood. But it came back negative.

Renal failure anemia
Image courtesy of: National Kidney & Urologic Diseases Information Clearinghouse (NKUDIC)

After all these tests, we diagnoses her with renal failure anemia. He then consulted the kidney doctor who reconfirmed the diagnosis of renal failure anemia and started her on an injection called erythropoietin commonly known as PROCRIT. It is a drug used to treat renal failure anemia.

Renal failure anemia develops as the diseased have decreased production of a certain chemical substance that is required to stimulate Red Blood Cells (RBC). The red cells are the main carriers of hemoglobin and hemoglobin is what carries oxygen in the blood. When doctors talk about a low blood level, it is usually the low hemoglobin level they are talking about. Patients with renal failure anemia are low in this chemical called erythropoietin or EPO.

Mrs. K was diagnosed with possible gastroenteritis. The diagnosis of renal failure anemia was a incidental diagnosis or a secondary diagnosis. It means that patient was not admitted to the hospital primarily for renal failure anemia. Renal failure anemia was discovered while she was being treated for another condition. She improved with IV fluids and antibiotics and need not need blood transfusion. She will be having regular follow up with her kidney doctor to see how her renal failure anemia improves with treatment.

I hope the story of Mrs. K helped you understand more about what renal failure anemia is how renal failure anemia is diagnosed. Please check back soon for more real patient stories that I will be uploading to help teach you more about different symptoms and diseases.

Thank You

Nabin Sapkota, MD