Renal anemia
| Classification according to ICD-10 | |
|---|---|
| D63.8 * | Anemia in other chronic diseases classified elsewhere |
| ICD-10 online (WHO version 2019) | |
A renal anemia refers to anemia due to acute or chronic kidney disease. The loss of function of the kidneys results in an erythropoietin deficiency, which means that too few red blood cells ( erythrocytes ) are formed. Almost all patients with chronic kidney disease and an increase in serum creatinine to more than 3–4 mg / dl develop renal anemia.
Emergence
Erythropoietin stimulates the progenitor cells of the erythrocytes in the bone marrow to proliferate and differentiate . 90 percent of it is produced in the kidneys and also in the liver, brain, uterus, testes and spleen. If the kidney is diseased, it no longer produces enough erythropoietin. As a result, the formation of red blood cells ( erythropoiesis ) takes place only to a limited extent. In addition, if you have kidney disease with an increased urea content in the blood, the erythrocyte survival time is reduced. In addition, bleeding caused by damage to the mucous membrane or frequent diagnostic blood withdrawals and dialysis treatment contribute to the development of renal anemia. Renal anemia is therefore a mixed form of anemia, ie various causes are involved in its development. Mixed forms are common and occur primarily in secondary anemia as a result of chronic diseases.
Symptoms
The severity of the underlying kidney disease, the greater the extent of renal anemia. In diabetics, the anemia often occurs early and in severe form. The main consequences of renal anemia are reduced physical performance, reduced mental activity and more frequent hospital stays. General symptoms of anemia can be tiredness, pale skin, shortness of breath and a high pulse. Dizziness and poor concentration also occur. Symptoms of renal anemia also include high blood pressure, gastrointestinal complaints or bone pain. Itching, menstrual cycle disorders or impotence can also appear as symptoms of kidney disease. The quality of life of those affected is significantly reduced overall.
Diagnosis
If the hemoglobin concentration indicates anemia, laboratory values such as the mean cell volume (MCV) or the reticulocyte count (preliminary stages of the erythrocytes) indicate the cause. If the blood cells have a normal cell volume, the anemia is usually secondary, i.e. caused by a chronic disease. If there are not enough reticulocytes, erythrocyte production (erythropoiesis) is impaired. In unclear cases, the bone marrow examination provides additional information.
therapy
The aim of erythropoietin therapy is to stabilize the Hb value at 11 to 12 g / dl. The uppermost Hb target value should "not intentionally exceed" 13 g / dl. Erythropoietin reduces the need for blood transfusions . Patients requiring dialysis benefit from erythropoietin therapy, as do patients with chronic kidney failure who are not yet on dialysis. The early treatment of anemia in patients with chronic kidney disease who do not require dialysis lowers the risk of cardiovascular diseases, hospital stays and the level of treatment costs.
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Individual evidence
- ↑ Alphabetical directory for the ICD-10-WHO version 2019, volume 3. German Institute for Medical Documentation and Information (DIMDI), Cologne, 2019, p. 50
- ↑ U. Kuhlmann: Nephrology. Georg Thieme Verlag, 2008.
- ↑ Schmidt, Lang: Physiologie des Menschen. 30th edition. Springer publishing house
- ↑ Andreas Ende: Anemia with kidney weakness (renal anemia). on: qimeda.de , December 8, 2011, accessed May 5, 2014.
- ↑ F. Locatelli et al.: Nephrol Dial Transplant . (2009); 24, pp. 348-354.
- ↑ C. Gouva et al .: Treating anemia early in renal failure patients slows the decline of renal function. In: Kidney Intl. (2004); 66, pp. 753-760.
- ↑ WX Lu et al .: Survival benefit of recombinant human v erythropoietin administration prior to onset of end-stage renal disease. In: Nphron Clin Pract. (2005); 101, pp. 79-86.
