[Anemia in chronic renal insufficiency--case report].

BACKGROUND

Chronic renal insufficiency is a clinical syndrome including increased urea in the serum and creatinine concentration with or without decrease of urine production. Numerous diseases may induce chronic renal insufficiency. In developed countries these are most often diabetes mellitus, glomerulonephritis and hypertension, whereas in developing countries these are bacterial infections, gall stone, tuberculosis and some parasitic diseases. Chronic renal insufficiency leads to functional disorders of all systems in the body, including hematopoiesis. Anemia is a common complication, while its degree depends on the degree of creatmemia. It is normocytic and normochromic. Anemia is caused by several factors, decreased erythropoietin synthesis being the most important. The stimulus for its secretion is tissue hypoxia. Erythropoietin synthesis is regulated by mechanism of negative retroaction and it stimulates proliferation. It also prevents apoptosis--programmed cell death. Other important factors causing anemia are uremic toxins, which decrease proliferation of erythroid progenitors, damage erythrocytes and shorten their life. Changes in the microvascular system of kidneys also cause anemia mechanically damaging erythrocytes and hemolysis. Patients with chronic renal insufficiency are susceptible to hemorrhages (erosions and duodenal ulcers) being one of the factors causing anemia. Recombinant erythropoietin production and its application in treatment of chronic renal insufficiency patients is of great importance. It is applied subcutaneously and intravenously, whereas the dosage and length of treatment are individual.

METHODS

A female patient, (M. R.) 69 years of age, has been treated at the Department of Internal Diseases of the Hospital in Senta 22 times during the last 30 years. Chronic renal insufficiency was caused by chronic pyelonephritis and hypertension. Up to two years ago she had several transfusions and received 7.480 ml of deplasmatic erythrocytes. The last transfusion was in May 1997, due to hemoglobin values lower than 80 g l. In August 1997, the patient acquired recombinant erythropoietin and was hospitalized and treated in our institution by subcutaneous application of erythropoietin (50 mu kg) every other day, with monitoring of hemoglobin, hematocrit, erythrocyte count increase and values of serum iron. The therapeutic response was good. 14 months later she was hospitalized again and the therapy was repeated. The last outpatient follow-up was on January 5, 1999, and hemoglobin was 92 g l.

CONCLUSIONS

Our case report shows that recombinant erythropoietin gives good results in treatment of anemia: correction of anemia, improvement of general status and there is no need for frequent transfusions and thus there are less complications.