Renal anemia (renal anemia) - Causes, Symptoms and Treatment .MF .
renal anemia (anemia of renal origin, renal anemia) - a decrease in the number of red blood cells and hemoglobin level in blood when kidney disease.
Causes of renal anemia
key role in the development of renal anemia plays a reduction in the synthesis of erythropoietin (hence another name for renal anemia - EPO deficiency anemia).Erythropoietin - a protein that regulates the formation and maturation of red blood cells.During the prenatal period and in infants children erythropoietin produced by the liver cells.With age it begins to be synthesized in the kidney cells.By reducing glomerular filtration rate below 30 ml / min reduced the formation of erythropoietin.As a result, the hemoglobin concentration falls.Additionally, metabolic products detrimental to kidney disease do not appear in the proper amount, inhibit the synthesis of erythropoietin.Acidosis (violation of the acid-base balance, associated with the accumulation of acids) halves the life span of red blood cells due to their destruction.
patients require hemodialysis sessions With the development of end-stage renal failure.Unreasonable frequent blood samples for analysis, and the blood that remains in the extracorporeal circuit after the dialysis procedure, contribute to the progression of anemia.
Iron and folic acid is a substrate for the formation of normal red blood cells.The defeat of the intestinal mucosa, characteristic for patients in the final stage of renal failure, prevents the absorption of their food to the extent necessary, as also contributes to the appearance of anemia.
symptoms of renal anemia
main role of red blood cells is the oxygen delivery to the cells of the body, so when all the organs of anemia experiencing oxygen starvation.
External manifestation of renal anemia develops gradually.In the initial stage attention is drawn to general weakness, drowsiness, fatigue, headache, dizziness, irritability.Later in the worsening of anemia appear pale skin, shortness of breath with little exertion, pain in the heart on the type of angina, the tendency to reduce blood pressure.
diagnosis of anemia is put at falling hemoglobin level below 130 g / l in men and 120g / l in women.
In addition, to assess the severity of anemia and to identify the causes that can reduce the synthesis of erythropoietin, the following laboratory tests are recommended:
• hemoglobin concentration and hematocrit to classify the severity of anemia.There are the following severity of anemia.
Light - hemoglobin levels below normal, but more than 90 g / l;
average - hemoglobin level 90-70 g / l;
Heavy - hemoglobin level less than 70 g / l.
• erythrocyte indices for the differential diagnosis of anemia types;
• absolute reticulocyte count to evaluate the activity of erythrocyte formation processes;
• Serum ferritin as a measure of iron stores in the body;
• The percentage of iron transferrin saturation to assess gland involvement in the formation of hemoglobin;
• The level 12 in the blood plasma;
• In dialysis patients the blood concentration of aluminum.Aluminium blood can be increased in case of insufficient clean water for dialysis.Also
anemia in patients with special methods to diagnose latent bleeding to be applied, for example, gastro-intestinal or rectal.For women with heavy menstruation recommended consulting a gynecologist for the normalization of hormonal levels.
Treatment of renal anemia
at a predialysis stage renal disease good effect gives application of iron and folic acid tablets.In the formation of all ESRD drugs for the treatment of anemia are administered intravenously.
Currently, there is rejection of blood transfusions (blood transfusion) to treat chronic anemia.This is due to the fact that blood can carry infectious agents such as hepatitis B and C and HIV.Until now remain valid severe allergic reactions that occur through blood transfusions.Patients who plan the operation of kidney transplantation, is inadmissible iron overload and activation of the immune system of the donor red blood cells.
In the second half of the twentieth century was created recombinant erythropoietin on the structure and properties are very similar to their own human erythropoietin.This has allowed to extend the life of patients with kidney failure, improve its quality and reduce the frequency of blood transfusions.Recombinant erythropoietin is assigned when the hemoglobin level below 90 g / l.The preferred route of administration is subcutaneous.The initial dose is 50 units per kilogram body weight and is adjusted on the basis of increase in hematocrit and blood hemoglobin.At the beginning of the treatment blood counts monitored 1 time in 2 weeks, and then the stabilization of indicators - 1 time per month.In our country, are allowed to use are the drugs of recombinant erythropoietin as Eprex, Epokrin, Recormon, Eralfon.When applying erythropoietin may increase blood pressure, and in the case of rapid increase in hemoglobin increased risk of thrombosis.
Together with erythropoietin shows the introduction of iron supplements.There tableted form (Sorbifer) and intravenous preparations (Venofer, Likferr 100 Argeferr), which are preferred on dialysis.The initial dose of intravenous iron is 100-200 mg per week, followed by a correction.Indicators exchange of iron in the body is determined every three months.
By reducing the content of folate in the blood shows the use of folic acid.On the predialysis stage of folic acid used in tablets, during renal replacement therapy - a form for intravenous administration.
physician therapist, nephrologist Sirotkin EV