The Effect of Roxadustat on Transfusion-Dependent Myelodysplastic Syndrome Complicated by Chronic Kidney Disease

Haematopoietic insufficiency is the treatment target of lower-risk myelodysplastic syndrome (MDS). Although erythropoiesis-stimulating agents (ESAs) are generally effective for treating anaemia, resistance can develop. Hypoxia-inducible factor-prolyl hydroxylase (HIF-PH) improves renal anaemia by promoting endogenous erythropoietin production and normalizing iron metabolism. HIF-PH inhibitors could be used to treat MDS, but their efficacy and safety have not been studied. A 78-year-old female patient with essential thrombocythemia gradually developed anaemia and was diagnosed with therapy-related MDS 4 years later. The anaemia temporarily improved with ESAs, but the patient became transfusion dependent. At the same time, anaemia and chronic renal failure due to nephrosclerosis progressed, and the patient was diagnosed with MDS with renal anaemia. After switching from ESAs to roxadustat, an HIF-PH inhibitor, anaemia improved, and the patient was no longer transfusion dependent. No progression of the underlying disease or any adverse events was observed 4 months after initiating roxadustat.

Effects of Angiotensin II on Erythropoietin Production in the Kidney and Liver

The kidney is a main site of erythropoietin production in the body. We developed a new method for the detection of Epo protein by deglycosylation-coupled Western blotting. Detection of deglycosylated Epo enables the examination of small changes in Epo production. Using this method, we investigated the effects of angiotensin II (ATII) on Epo production in the kidney. ATII stimulated the plasma Epo concentration; Epo, HIF2α, and PHD2 mRNA expression in nephron segments in the renal cortex and outer medulla; and Epo protein expression in the renal cortex. In situ hybridization and immunohistochemistry revealed that ATII stimulates Epo mRNA and protein expression not only in proximal tubules but also in collecting ducts, especially in intercalated cells. These data support the regulation of Epo production in the kidney by the renin–angiotensin–aldosterone system (RAS).

PENGARUH PEMBERIAN JUS BAYAM MERAH (AMARANTHUS GANGETICUS) TERHADAP PENINGKATAN KADAR HEMOGLOBIN PADA IBU HAMIL PENDERITA ANEMIA DI KLINIK SALMA KEC.PERBAUNGAN TAHUN 2020

Anemia in pregnant women greatly affects iron deficiency, because in pregnancy the need for oxygen is higher, which triggers an increase in erythropoietin production (Cunninggham, 2016). (WHO, 2010), globally the prevalence of anemia in pregnant women worldwide is 41.8%. The prevalence of anemia in pregnant women in Indonesia increased compared to 2013, in 2013 as many as 37.1% of pregnant women were anemic while in 2018 it increased to 48.9% (Riskesdas, 2018). One alternative to meet iron needs can be done by consuming vegetables, one of which is red spinach. The aim is to determine the effect of giving red spinach juice on increasing hemoglobin levels in pregnant women with anemia at the Salma Clinic, Perbaungan district in 2020. The method of pre-experimental research was one group pretest-posttest study design. The population in this study were all 28 pregnant women. January to May 2020. Sampling using purposive sampling technique. To determine the differences in the production of Hb levels before and after intervention in pregnant women and Hb Check. The statistical test used in this study was the paired sample T-Test, if the p value was ≤ 0.05. The results of the analysis test using paired sample t-test in the experimental group obtained a value of p = 0.025 <(α = 0.05), it can be concluded that the hypothesis in this study was accepted, namely the effect of giving red spinach juice on pregnant women with anemia at the Salmah Perbaungan Clinic, Serdang Bedagai Regency

High serum creatinine in early life of preterm infants predicts the severe retinopathy of prematurity: a retrospective single-centre study

BACKGROUND Hypoxia and anemia are among the risk factors for retinopathy of prematurity (ROP). The kidneys are important organs that sense oxygen levels and regulate red blood cell synthesis via erythropoietin production. We investigated the contribution of abnormal renal function (reflected by serum creatinine [SCr] levels) to severe ROP in very low birth weight (VLBW) infants. METHODS In the present study, we enrolled 242 VLBW infants of gestational age (GA) ranging between 25 and 32 weeks who were admitted at Soonchunhyang Cheonan University Hospital between Nov 2014 and Dec 2019. The cut-off value for normal SCr for each GA group based was defined as 95th percentile of SCr based on a reference chart developed in a previous study. Risk factors for ROP requiring treatment were analyzed using logistic regression. RESULTS Of the 242 infants, 63 (26%) were high SCr group and 30 (12.4%) infants had ROP requiring treatment. GA (odds ratio 0.38, 95% confidence interval 0.23–0.61) and high SCr group (4.68 [1.10–19.90]) were independent factors for ROP requiring treatment. CONCLUSIONS In VLBW infants, high SCr within the first 4 weeks after birth is one of the risk factors for ROP requiring treatment.

Retinoic acid regulates erythropoietin production cooperatively with hypoxia-inducible factors in human iPSC-derived erythropoietin-producing cells

Erythropoietin (EPO) is a crucial hormone for erythropoiesis and produced by adult kidneys. Insufficient EPO production in chronic kidney disease (CKD) can cause renal anemia. Although hypoxia-inducible factors (HIFs) are known as a main regulator, the mechanisms of EPO production have not been fully elucidated. In this study, we aimed to examine the roles of retinoic acid (RA) in EPO production using EPO-producing cells derived from human induced pluripotent stem cells (hiPSC-EPO cells) that we previously established. RA augmented EPO production by hiPSC-EPO cells under hypoxia or by treatment with prolyl hydroxylase domain-containing protein (PHD) inhibitors that upregulate HIF signals. Combination treatment with RA and a PHD inhibitor improved renal anemia in vitamin A-depleted CKD model mice. Our findings using hiPSC-EPO cells and CKD model mice may contribute to clarifying the EPO production mechanism and developing efficient therapies for renal anemia.

Anemia in Chronic Kidney Disease : Role of Hypoxia Inducible Factor Stabilizer

A B S T R A C TAnemia contributes to increased morbidity and mortality in chronic kidney diseasepatients. The pathogenesis of anemia in these patients is multifactorial, but thecontribution of erythropoietin deficiency becomes greater as glomerular filtrationrate declines which related to decreased nephron mass. The current standard ofcare includes supplemental iron, erythropoiesis-stimulating agents (ESA), and redblood cell transfusions, although each has drawbacks. Lately, concern has arisenfollowing randomized clinical trials showing that higher hemoglobin targets and/orhigh ESA doses may cause significant harm including increasing cardiovascular andthrombotic events, and even death. Recent experimental and clinical studies showthe promising efficacy of hypoxia inducible factor (HIF) stabilizer which stimulatesendogenous erythropoietin production and enhance iron availability.