Renal anemia

A renal anemia is a kidney-related anemia that can be traced back to disorders of erythropoiesis (synthesis of red blood cells) caused by kidney insufficiency. The extent of renal anemia is determined by the severity of the underlying renal insufficiency. Renal anemia is usually well treatable with medication.

What is Renal Anemia?

As renal anemia is a term for anemia caused by kidney failure (underactive kidney function), which is due to a lack of erythrocytes in the blood.

The reduced number of erythrocytes, which ensure the transport of oxygen in the blood via the hemoglobin (red blood pigment), leads to an oxygen deficiency in the body and causes the symptoms typical of renal anemia such as paleness, rapid symptoms of fatigue and shortness of breath.

The likelihood of developing renal anemia increases with progressive renal failure. With advanced renal insufficiency (dialysis requirement, required kidney transplantation), renal anemia is diagnosed in most cases.

causes

A renal anemia is caused by chronic kidney failure, which in turn can have different causes. Long-term diabetes, excessive consumption of painkillers and inflammatory diseases of the kidneys can lead to kidney failure and renal anemia at an early stage.

Healthy kidneys produce over four-fifths of the need for erythropoietin, a hormone that stimulates erythropoiesis (erythrocyte synthesis) in the bone marrow. In the case of renal insufficiency, this hormone is only produced in insufficient quantities, so that too few erythrocytes are synthesized and renal anemia develops.

A reduced lifespan of the erythrocytes and impaired iron uptake by hemoglobin can also be attributed to renal insufficiency and thus cause renal anemia.

Symptoms, ailments & signs

Symptoms of anemia are typical symptoms of anemia caused by kidney failure. As a result of the reduced supply of oxygen, performance is reduced, and patients feel tired and exhausted. Dizziness and headaches may occur.

The skin and mucous membranes are pale, they have a color similar to coffee with milk. Exercise leads to shortness of breath (dyspnoea). At first the breathing difficulties improve at rest, but in the advanced stages of anemia they persist even at rest. The tongue looks red and smooth, what medical professionals call the lacquer tongue.

In addition to the symptoms caused by the anemia, other symptoms are caused by the dysfunction of the kidneys. The blood pressure rises, the ability to concentrate decreases and states of confusion are possible. The digestive tract is also affected, causing diarrhea, abdominal pain, nausea, and vomiting.

People often lose weight through loss of appetite. So-called uremic changes such as dryness, flaking and itching appear on the skin. The latter can be so strong that patients scratch their skin. It is not uncommon for these scratch marks to become infected. The damage to the kidneys can lead to menstrual disorders and impotence. In some cases there are sensory disorders, calf cramps and bone pain. Increased heartbeat, palpitations and cardiac arrhythmias are also possible.

Diagnosis & course

Diagnosing a renal anemia takes place on the basis of a blood count analysis, in the course of which the blood cell count, the hemoglobin and the hematocrit value (total proportion of blood cells in the blood) are determined. Renal anemia can be assumed if the level of red blood cells is normal and the hemoglobin level is normal and / or the hematocrit level is reduced.

In the initial stage of renal anemia, symptoms are often not discernible at rest, while symptoms of fatigue as well as weakness and shortness of breath can quickly occur due to exercise. In the case of advanced renal anemia, these symptoms can also be observed at rest. Renal anemia is also associated with an increased cardiac output, since the organism tries to compensate for the lack of oxygen by increasing the heart rate.

Since renal anemia is caused by renal insufficiency, the symptoms characteristic of kidney damage (pale skin, jaundice, gastrointestinal complaints, etc.) can be observed depending on the extent and stage of the kidney disease. Renal anemia that is not treated leads to a long-term physical and mental decline in performance and a shortened life expectancy.

Complications

Renal anemia often leads to complications, but these always depend on the type and severity of the underlying disease. Diabetics, for example, are at greatest risk of suffering from severe renal anemia at an early age. However, if there is slight kidney damage, the anemia is mild and shows few symptoms. In severe cases, fatigue, a drop in performance, mental deterioration with states of confusion, shortness of breath and increased pulse occur.

In addition, it can lead to high blood pressure, bone pain and gastrointestinal complaints. Overall, there is a great risk of serious cardiovascular disease. This applies all the more, the later treatment of renal anemia begins in patients who are not yet on dialysis. In addition, the number of hospital stays and of course the treatment costs also increase.

Overall, untreated renal anemia has a negative impact on the performance of the body and mind. In addition, there is a drastic reduction in life expectancy. The loss of quality of life for the patient is also serious. Due to the chronic complaints, those affected can also develop mental illnesses.

The risk of developing depression is particularly increased. Since the hormone erythropoietin (EPO) is missing in renal anemia, it must be added as part of the therapy. The risks of this therapy are small, but can initially lead to an increase in blood pressure and a slight increase in the risk of thrombosis.

When should you go to the doctor?

This condition should always be treated by a doctor. In the worst case, if left untreated, the affected person can die. Usually this disease can be treated relatively well with the help of medication. First and foremost, a doctor should be consulted if the patient suffers from impaired oxygen uptake. This often leads to severe fatigue and dizziness. Severe headaches that persist can also indicate the disease.

In most cases, the affected person's skin also appears very pale and shortness of breath occurs. Furthermore, severe digestive problems or a loss of appetite also indicate the disease. The patient's skin is red and itchy. If these complaints occur over a longer period of time and make life difficult for the person affected, a doctor should definitely be consulted. As a rule, the disease can be treated well, so that the life expectancy of the person affected is not reduced. However, a complete cure is usually not achieved, so that the patient is dependent on lifelong treatment.

Treatment & Therapy

A renal anemia is treated with medication. If the renal anemia is due to an erythropoietin deficiency, which is the norm, genetically synthesized erythropoietin is injected to eliminate the hormone deficiency (EPO therapy or erythropoietin substitution).

The erythropoietin substitution compensates for the hormone deficiency and stimulates blood formation, which is why additional iron intake may be necessary. A sufficient amount of iron is an essential prerequisite for erythropoiesis. The increased iron requirement can be guaranteed through an appropriate nutrition plan and additional iron supplements.

Since the absorption of iron in the gastrointestinal tract through tablets (oral iron therapy) is only possible to a limited extent and can in many cases lead to digestive disorders and nausea, intravenous administration (parenteral iron therapy) is recommended in cases of renal anemia.

With an erythropoietin substitution, blood transfusions and the associated risks (viral diseases, excessive immune system reactions, inhibition of the body's own erythrocyte production) are avoided. The risk of cardiovascular disease is minimized for those affected who are not yet required to dialysis.

In the case of a kidney transplant, an improvement in the renal anemia can usually be observed, since the cause of the renal anemia has been eliminated with the new kidney and sufficient erythropoietin can be produced.

prevention

There one renal anemia caused by renal insufficiency, preventive measures aim to avoid kidney damage. This includes a healthy diet and the early treatment of diseases that can cause kidney failure (diabetes mellitus, inflammatory kidney diseases) and thus renal anemia. Regular blood tests in the case of chronic kidney failure contribute to the early diagnosis and elimination of renal anemia.

Aftercare

Follow-up care for renal anemia depends on its cause. In any case, regular blood tests are required in order to be able to react immediately if necessary. The doctor determines the cycle. If the kidney is the trigger, it is best to see a nephrologist.

The control may be necessary monthly or, if it manifests, at longer intervals. Especially with renal insufficiency, it can be assumed that renal anemia will recur. It is then important to check for at least the following blood values: hemoglobin and GFR (urine production by the kidneys). As soon as the GFR drops below 15 ml / min, kidney failure occurs. Hemoglobin (Hb) should not drop below 11 g / dL. Hemoglobin is the iron-containing and therefore red blood pigment that is responsible for transporting oxygen in the blood.

The iron content can be increased with iron tablets or an injection. As soon as the hemoglobin level falls again, erythropoietin (EPO) must be administered again, the effect of which is delayed by several weeks. EPO is the hormone that stimulates blood formation in the bone marrow. Since the blood pressure can rise here, this must also be checked and noted daily during follow-up care. On the basis of a documentation of the blood pressure values, the doctor can decide whether treatment with blood pressure lowering agents should be used.

You can do that yourself

Patients suffering from renal anemia can positively influence the success of the treatment by changing their diet. Since iron deficiency is associated with anemia, it is necessary to consume foods that contain iron. Especially when those affected cannot tolerate the corresponding medication (such as tablets) well. Foods containing iron include meat, whole grain products and legumes in particular. It is advisable to ensure an adequate supply of vitamin C (e.g. through a glass of orange juice) when consuming them, as this facilitates the absorption of iron in the body.

Depending on the stage of renal anemia, a healthy amount of exercise can also have a positive impact on the body. Relaxation exercises and movement lead to a better body feeling and can also cause accompanying illnesses, such as B. relieve cardiovascular problems. The contact and exchange with like-minded people in a self-help group can also have a very positive effect on patients and their well-being.

However, going to the doctor is essential. Because only with drug treatment can the symptoms of renal anemia be treated permanently. Those affected should have their blood values ​​checked regularly in order to be able to intervene early in the event of any deterioration.