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.
CASE REPORT: 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.
CONCLUSION: 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.