Nephrogenic anemia( renal anemia) - Causes, symptoms and treatment. MF.

Nephrogenic anemia( anemia of renal origin, renal anemia) is a decrease in the number of red blood cells and hemoglobin level in kidney disease.

Causes of nephrogenic anemia

A key role in the development of nephrogenic anemia is played by a decrease in the synthesis of erythropoietin( hence the other name for nephrogenic anemia is EPO-deficient anemia).Erythropoietin is a protein that regulates the formation and maturation of erythrocytes. In the intrauterine period and in newborn infants, erythropoietin produces liver cells. With age, it begins to be synthesized in kidney cells. With a decrease in the glomerular filtration rate below 30 ml / min, the formation of erythropoietin decreases. As a result, the concentration of hemoglobin decreases. In addition, harmful metabolic products, which, when kidney disease is not eliminated in the proper amount, interfere with the synthesis of erythropoietin. Acidosis( violation of acid-base equilibrium, associated with the accumulation of acids) halves the life span of erythrocytes due to their destruction.

With the development of terminal renal failure, patients need to undergo hemodialysis sessions. Unreasonable frequent blood samples for analysis, as well as blood remaining in the extracorporeal circuit after the completion of the dialysis procedure, contribute to the progression of anemia.

Iron and folic acid are the substrate for the formation of normal red blood cells. The defeat of the intestinal mucosa, typical for patients in the final stage of renal failure, prevents their absorption from food in the required volume, which also contributes to the appearance of anemia.

Symptoms of nephrogenic anemia

The main role of erythrocytes is the delivery of oxygen to the cells of the body, so when anemia, all organs experience oxygen starvation.

External manifestations of nephrogenic anemia develop gradually. In the initial stage, attention is drawn to general weakness, drowsiness, loss of strength, headache, dizziness, irritability. In the future, with anemia worsening, skin pallor, dyspnea with insignificant physical exertion, pain in the heart area by the type of angina pectoris, a tendency to lower blood pressure.

Survey

The diagnosis of anemia is made when the level of hemoglobin falls below 130 g / l in men and 120 g / l in women.

In addition, the following laboratory tests are recommended to assess the severity of anemia and identify causes that may reduce the synthesis of erythropoietin:

• The concentration of hemoglobin and hematocrit for the classification of anemia in severity. Allocate the following severity of anemia.
Lung - hemoglobin level is below normal, but above 90 g / l;
Medium - level of hemoglobin 90-70 g / l;
Heavy - the level of hemoglobin is less than 70 g / l.
• Red cell indices for differential diagnosis of anemia types;
• Absolute amount of reticulocytes for evaluation of the activity of erythrocyte formation processes;
• Serum ferritin as an indicator of iron stores in the body;
• Percentage of transferrin saturation with iron to assess the participation of iron in the process of hemoglobin formation;
• Level B 12 in the blood plasma;
• In dialysis patients, the concentration of blood aluminum. Aluminum of blood can be increased in conditions of insufficient water purification for dialysis.

Also in patients with anemia, special methods should be used to diagnose latent bleeding, for example, gastrointestinal or rectal. For women with profuse menstruation recommended by a gynecologist for normalization of the hormonal background.

Treatment of nephrogenic anemia

In pre-dialysis stages of renal failure, a good effect is provided by the use of iron and folic acid preparations in tablets. In the formation of terminal renal failure, all drugs for the treatment of anemia are administered intravenously.

Currently, there is a rejection of blood transfusions( blood transfusions) for the treatment of chronic anemias. This is due to the fact that infectious agents such as hepatitis B, C, HIV can be transmitted with blood. Until now, severe allergic reactions that occur with blood transfusions are relevant. In patients who plan a kidney transplant operation, iron overload and activation of the immune system by the donor's erythrocytes are inadmissible.

In the second half of the twentieth century, recombinant erythropoietin was created, in structure and properties very similar to the human erythropoietin itself. This allowed to prolong the life of patients with renal insufficiency, improve its quality and reduce the frequency of blood transfusions. Recombinant erythropoietin is prescribed at a hemoglobin level below 90 g / l. Preferably a subcutaneous route of administration. The initial dose is 50 units per kilogram of body weight and is further adjusted based on the increase in hemoglobin and hematocrit blood. At the beginning of treatment, blood counts are monitored 1 time in 2 weeks, then when the indicators are stabilized - once a month. In our country, such preparations of recombinant erythropoietin as Eprex, Epokrin, Recormon, and Eralfon are allowed. With the use of erythropoietin, an increase in blood pressure is possible, and in the case of a rapid increase in hemoglobin, the risk of vascular thrombosis increases.

Together with erythropoietin shows the introduction of iron preparations. There are tableted forms( Sorbifer) and intravenous preparations( Venofer, Likferr 100, Argeferr), which are preferred for dialysis. The initial dose of intravenous iron is 100-200 mg per week with subsequent correction. The parameters of iron metabolism in the body are determined every three months.

With the decrease in folate content in the blood shows the use of folic acid preparations. At the pre-dialysis stage, folic acid is used in tablets, during the period of renal replacement therapy - a form for intravenous administration.

Physician therapist, nephrologist Sirotkina EV