A patient has anemia with severely reduced eGFR (8 mL/min) and elevated creatinine. What is the most likely presumptive diagnosis?

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Multiple Choice

A patient has anemia with severely reduced eGFR (8 mL/min) and elevated creatinine. What is the most likely presumptive diagnosis?

When the kidneys fail, they produce less erythropoietin, the hormone that drives red blood cell production. Severe kidney disease with a very low eGFR and high creatinine leads to an underproduced, normocytic, normochromic anemia because the bone marrow isn’t receiving enough EPO stimulus. This is the anemia of chronic kidney disease. Iron deficiency anemia would more likely be microcytic and tied to depleted iron stores. Aplastic anemia presents with pancytopenia and a hypocellular marrow, not specific to kidney function. Hemolytic anemia shows signs of red cell destruction and a brisk, inappropriate reticulocyte response, not the blunted response seen with EPO deficiency in CKD.

When the kidneys fail, they produce less erythropoietin, the hormone that drives red blood cell production. Severe kidney disease with a very low eGFR and high creatinine leads to an underproduced, normocytic, normochromic anemia because the bone marrow isn’t receiving enough EPO stimulus. This is the anemia of chronic kidney disease.

Iron deficiency anemia would more likely be microcytic and tied to depleted iron stores. Aplastic anemia presents with pancytopenia and a hypocellular marrow, not specific to kidney function. Hemolytic anemia shows signs of red cell destruction and a brisk, inappropriate reticulocyte response, not the blunted response seen with EPO deficiency in CKD.

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