An Unusual Occurrence of Erythrocytosis in a Child with Nephrotic Syndrome and Advanced Chronic Kidney Disease

Background: Anemia is common in patients with nephrotic syndrome (NS) for various reasons. Furthermore, anemia can occur in patients with chronic kidney disease (CKD) predominantly owing to inappropriately low erythropoietin (EPO) production relative to the degree of anemia. However, erythrocytosis is uncommon in patients with NS and advanced CKD who are not treated with exogenous erythropoietin stimulating agents, and when present, will necessitate exploration of the other etiologies. Case summary: Here, we describe an 8-year-old girl with erythrocytosis in association with NS and advanced CKD. The patient was found to have erythrocytosis during the evaluation for hypertensive urgency. She also had nephrotic range proteinuria without edema. Serum hemoglobin and hematocrit were 17 gm/dL and 51%, respectively, despite hydration. Renal function test showed an estimated glomerular filtration rate of 30 mL/min/1.73 m2. There was mild iron deficiency anemia with serum iron saturation of 18%. Serum EPO level was normal. Urine EPO was not measured. Renal biopsy showed evidence of focal segmental glomerulosclerosis. Genetic testing for NS showed mutations in podocyte genes: NUP93, INF2, KANK1, and ACTN4. Gene sequence analysis of genes associated with erythrocytosis showed no variants in any of these genes. She required chronic dialysis ten months later and, subsequently, a renal transplantation 14 months after the initial presentation. Conclusion: Since the serum EPO level was normal, an increased sensitivity to EPO is the most probable mechanism of erythrocytosis. The unusual association of erythrocytosis in patients with NS and advanced CKD needs to be studied further in larger studies.

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Levels of Hemoglobin, Leukocytes, and Platelets of Chronic Kidney Disease Patients Undergoing Hemodialysis in Surabaya

Biomolecular and Health Science Journal ◽

10.20473/bhsj.v1i1.8190 ◽

2018 ◽

Vol 1 (1) ◽

pp. 29

Author(s):

Mega Kahdina ◽

Nunuk Mardiana ◽

Dyah Fauziah

Keyword(s):

Chronic Kidney Disease ◽

Peritoneal Dialysis ◽

Kidney Transplantation ◽

Kidney Disease ◽

Treatment Cost ◽

Conservative Therapy ◽

Deficiency Anemia ◽

Reverse Correlation ◽

Iron Saturation ◽

High Treatment

Background: Chronic kidney disease (CKD) is increasing in Indonesia, furthermore, it requires high treatment cost such as conservative therapy and kidney transplantation or dialysis. There are two types of dialysis; hemodialysis (HD) and peritoneal dialysis. The patient who undergoes HD needs periodical laboratories evaluation due to its impact on hemoglobin (Hb), leukocyte and platelets. The purpose of this study was to obtain the levels of Hb, leukocyte and platelets regularly in stage 5 CKD patients undergoing HD.Methods: Data were collected from patients’ medical record from October to December 2014 and it was characterized based on age, sex, HD frequency, HD period, hemoglobin, iron saturation, ESA (erythropoiesis-stimulating agent), leukocyte level and platelets level. 60 samples were included with the same ratio.Results: The average of age was 45 years old and the average of HD period was 40 months. All patients suffered anemia, however, only 51 patients could be evaluated the iron saturation. From it, 37 patients had the iron saturation of ≥20% which 14 (38%) of them received ESA. There were 14 patients who suffered zinc deficiency anemia with the iron saturation of <20% which 4 (29%) of them received ESA.Conclusion: Most of patients’ leukocyte and platelets levels were normal. Patients who received ESA had higher Hb levels. Platelets levels had a reverse correlation with the longer period of hemodialysis.

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Ferric Citrate Dosing in Iron Deficiency Anemia in Nondialysis-Dependent Chronic Kidney Disease

American Journal of Nephrology ◽

10.1159/000516012 ◽

2021 ◽

pp. 1-10

Author(s):

Pablo E. Pergola ◽

Diogo Belo ◽

Paul Crawford ◽

Moustafa Moustafa ◽

Wenli Luo ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Ferric Citrate ◽

Deficiency Anemia ◽

Open Label ◽

Starting Dose ◽

Dosing Regimens

Introduction: Ferric citrate (FC) is indicated as an oral iron replacement for iron deficiency anemia in adult patients with chronic kidney disease (CKD) not on dialysis. The recommended starting dose is one 1-g tablet three times daily (TID). This study investigated long-term efficacy and safety of different FC dosing regimens for treating anemia in nondialysis-dependent CKD (NDD-CKD). Methods: In this phase 4, randomized, open-label, multicenter study, patients with anemia with NDD-CKD (estimated glomerular filtration rate, ≥20 mL/min and <60 mL/min) were randomized 1:1 to one FC tablet (1-g equivalent to 210 mg ferric iron) TID (3 g/day) or 2 tablets twice daily (BID; 4 g/day). At week 12, dosage was increased to 2 tablets TID (6 g/day) or 3 tablets BID (6 g/day) in patients whose hemoglobin (Hb) levels increased <0.5 g/dL or were <10 g/dL. Primary endpoint was mean change in Hb from baseline to week 24. Results: Of 484 patients screened, 206 were randomized and 205 received FC. Mean (standard deviation) changes from baseline in Hb at week 24 were 0.77 (0.84) g/dL with FC TID 3 g/day and 0.70 (0.98) g/dL with FC BID 4 g/day. Discussion/Conclusions: FC administered BID and TID for 48 weeks was safe and effective for treating anemia in this population, supporting potentially increased dosing flexibility.

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Role of Serum Transferrin Receptor in Diagnosing and Differentiating Iron Deficiency Anemia from Anemia of Chronic Disease in Patients with Chronic Kidney Disease

BIRDEM Medical Journal ◽

10.3329/birdem.v7i2.32451 ◽

2017 ◽

Vol 7 (2) ◽

pp. 132-137

Author(s):

Abdul Latif ◽

Muhammad Rafiqul Alam ◽

Asia Khanam ◽

Farhana Hoque ◽

Muhammad Abdur Rahim ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Chronic Disease ◽

Kidney Disease ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Transferrin Receptor ◽

Deficiency Anemia ◽

Control Group ◽

Anemia Of Chronic Disease ◽

Female Ratio

Background: Anemia is common in patients with chronic kidney disease (CKD) and this is generally anemia of chronic disease, but iron deficiency anemia (IDA) is also common. Soluble transferrin receptor (sTfR) is a useful marker for IDA. Present study was undertaken to assess the utility of sTfR as a marker of IDA in selected group of Bangladeshi patients with CKD.Methods: This cross-sectional study was conducted in the Department of Nephrology, BSMMU, Dhaka, Bangladesh from January 2013 to December 2014. Patients with anemia admitted in nephrology department whether on hemodialysis or not and medicine department of BSMMU were taken for study. The study population was further divided into two groups; Group A, patients who are having IDA and Group B, patients with ACD and a control group was also selected. Data were collected by face to face interview and laboratory investigations with a self-administered questionnaire.Results: The mean age of the patients in two study groups were 38.40±13.23 and 34.85±10.52 years respectively and male-female ratio were 0.5:1 and 1:0.5. Mean sTfR level was higher (4.81± 1.64 ?g/ml) in patients with IDA than (2.89±1.40 ?g/ml) in patients with ACD (p <0.0001). In our study mean ferritin level was 599.59± 449.15?g/L in ACD patients whereas 101.23±119.42 in IDA patients (p<0.0001). Total iron binding capacity (TIBC) was more in ACD patients with sTfRe3?g/ml as compared to ACD patients with sTfR<3?g/ml. Transferrin saturation (TSAT) level was significantly decreased in ACD patients with sTfR ?3?g/ml as compared to ACD patients with sTfR<3?g/ml.Conclusion: sTfR has a comparable ability to S. ferritin in diagnosing IDA and ACD. However, sTfR and serum ferritin alone cannot definitely exclude co-existing iron deficiency in ACD. As sTfR is not affected by infection and/or inflammation, thus providing a non-invasive alternative to bone marrow study.Birdem Med J 2017; 7(2): 132-137

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Iron-deficiency Anemia and Chronic Kidney Disease: An Overview

10.5005/jp-journals-10065-0037 ◽

2018 ◽

Vol 2 (3and4) ◽

pp. 85-89

Author(s):

Garima Sharma ◽

Richa Saxena ◽

Nikhita Gulati

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Iron Deficiency ◽

Iron Deficiency Anemia ◽

Deficiency Anemia

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Renal disease

Oxford Handbook of Nutrition and Dietetics ◽

10.1093/med/9780199585823.003.0029 ◽

2011 ◽

pp. 631-656

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Nephrotic Syndrome ◽

Kidney Disease ◽

Renal Disease ◽

Nutritional Assessment ◽

Kidney Injury ◽

Nutritional Requirements ◽

P Nutrition ◽

Disease Stages

Introduction 632 Nutritional assessment 634 Malnutrition in renal disease 636 Nutritional considerations in chronic kidney disease 638 Nutrition in acute kidney injury 641 Nutrition in chronic kidney disease stages 3 and 4 642 Nephrotic syndrome 644 Nutritional requirements in dialysis 646 Nutritional requirements in haemodialysis ...

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