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E-book Treatment of Refractory Renal Anemia

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Penilaian

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A 32-year-old female patient presented with persistent general fatigue, chest tight-ness, palpitations, and dizziness for 2 weeks. Prior to admission, she did not report any recognized causes for these symptoms. She denied experiencing any skin, oral, or nasal bleeding, fever, gastrointestinal distress, abdominal pain, diarrhea, ery-thema, joint pain, or any other discomfort. Routine blood tests revealed abnormal values, including a hemoglobin level of 60 g/L, red blood cell count of 2.5 × 101?2/L, white blood cell count of 3.8 × 109/L, and platelet count of 148 × 109/L. The patient had a past medical history of systemic lupus erythematosus and lupus nephritis (class III) and was currently receiving treatment with 10 mg prednisone daily, 0.1 g hydroxychloroquine twice daily, and 100 mg aspirin daily.The postadmission renal function test revealed notable elevations in urea (18.90 mmol/L), creatinine (382.0 ?mol/L), and uric acid (453.00 ?mol/L), accom-panied by a high cysteine protease inhibitor C level (3.91 mg/L). The estimated glomerular filtration rate (eGFR, EPI) was 10 mL/min, and the total 24-h urinary protein concentration was 383.4 mg. Urine analysis revealed urinary protein ± and hematuria with a microscopic red blood cell count of 29.1/HPF, while the white blood cell count was 1.4/HPF. Her routine blood examination revealed a white blood cell count of 4.47 × 109/L, with 74.3% neutrophils. Hemoglobin levels had decreased to 55 g/L, which is indicative of severe anemia, whereas the platelet count was 220 × 109/L, and the reticulocyte count was 0.026. The patient’s albumin level was low at 30.4 g/L, and her erythropoietin (EPO) level was 7.80 IU/L. Folic acid and vitamin B12 levels were normal. Complement C3 was 0.82 g/L, and comple-ment C4 was 0.27 g/L. The testing also revealed that the titer of anti-dsDNA antibodies was 22.24 IU/ml, and the titer of antinuclear antibodies was 1:160. Anti-neutrophil cytoplasmic antibody titers were negative, and no significant abnormali-ties were noted in other biochemical tests. Tests related to hemolytic anemia also returned negative results. Imaging and electrocardiogram examinations revealed no significant abnormalities.The assessment of renal function indicated that the patient’s kidney dysfunction had reached stage 5, with a poor renal structure by kidney ultrasound detection. Additionally, we identified severe iron deficiency in this patient, manifesting as sig-nificantly reduced levels of serum iron, total iron-binding capacity, and ferritin (serum iron: 5.9 ?mol/L; total iron-binding capacity: 35.80 ?mol/L; ferritin: 97.00 ?g/L; and soluble transferrin receptor: 26.31 nmol/L). Despite the patient’s history of systemic lupus erythematosus, her lupus activity was not significant, with a Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score of less than 4. For this patient, our treatment plan entailed iron supplementation, which began with intravenous iron administration of 100 mg for 5 consecutive days, fol-lowed by daily oral iron supplementation with ferrous succinate at a dose of 200 mg. Regular hemodialysis was scheduled three times per week, and the patient also received EPO injections once weekly, with each injection containing 10,000 units. After a 3-month follow-up period, we observed a significant increase in the patient’s ferritin, serum iron, and total iron-binding capacity. However, her hemoglobin lev-els remained consistently below 100 g/L, and regular assessments indicated no sig-nificant lupus disease activity. Given these findings, we believe that the combination of erythropoietin and iron supplementation had reached its therapeutic limit in this patient, and further benefits were unlikely.

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Ketersediaan

Informasi Detail

Judul Seri

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No. Panggil

617.75 BIA t

Penerbit

Singapore : Springer Nature., 2025

Deskripsi Fisik

201 hlm

Bahasa

English

ISBN/ISSN

9789819776368

Klasifikasi

617.75

Tipe Isi

text

Tipe Media

computer

Tipe Pembawa

online resource

Edisi

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Subjek

-

Info Detail Spesifik

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Pernyataan Tanggungjawab

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Versi lain/terkait

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