Category Archives: Anemia

By way of introduction, I a dialysis patient in Mauritius. Been on dialysis for 6 years. My Hgb keeps training low. Despite I do Mircera 75mg twice a month, I need to do blood transfusion. Am of rare cases or 1st case in Mauritius to continuously have menstrual bleeding. Can be twice month for consecutive 15 days, then can stop 5 days and start again. On the Gyn side all tests are OK. I also get side effects and start bleeding when I do Recormon and Eprex. The government supply Recormon is free at the center but I am currently buying Mircera. Due to the recurring bleeding my Hgb is not stabilizing.Your advice would be much appreciated. With thanks and kind regards.

I am not an expert in menstrual bleeding, however, if you are having abnormal bleeding and this cannot be compensated by the Mircera, then the bleeding must be stopped. You should also have careful screening for and replacement for iron … Continue reading

Posted in Anemia, Ask the Doctor, Chronic Kidney Disease, Dialysis, Kidney-Related Health Questions

My son is 10 years post kidney transplant. His hemoglobin has been slowly declining for the past two years and he is anemic. A month ago he started taking iron, however his hemoglobin continues to decline, currently at 9.1. He is also losing weight without trying, about five pounds per month since February. I am concerned about this. It sounds like his hematologist wants him to start getting a shot, I’m sorry, but I don’t know the name of medication. I remember he had shots for anemia prior to his transplant. Can you give me some general information about what could be happening? Thank you for your time.

Progressive anemia has many causes including failure of the kidney transplant.  A hematologist should be able to tell if the anemia is from kidney failure versus some other cause.  The anemia shots are likely some form of erythropoiesis stimulating agent … Continue reading

Posted in Anemia, Ask the Doctor, Kidney Failure, Kidney-Related Health Questions, Nephrologist, Transplantation

My son is active on the Transplant list due to a genetic kidney disease and is also a competitive college athlete. His coaches have said that because he is “not in shape” he cannot play. Often he has trouble keeping up in the conditioning program because he is fatigued easily. His GFR is 20 creatinine is 3.9 Is his kidney condition what is really holding him back or is he out of shape?

There have been several professional athletes that have had advanced kidney disease and still able to play professional sports.  Hence, kidney disease does not preclude physical conditioning but the anemia and the fatigue do make the conditioning more difficult.  I … Continue reading

Posted in Anemia, Ask the Doctor, Chronic Kidney Disease, GFR, Kidney-Related Health Questions, Serum Creatinine, Symptoms and Side Effects

Dear Dr. Spry, I am sorry for my long question because I would like to share my confusion that has been bugging me for a while. My dad is 62 and currently on dialysis twice a week. It has been going on for 9 months. These past months, I noticed that my dad is experiencing excessive fatigue. He often falls asleep anytime during the day easily. I am really worried and confused because this condition has affected his daily activities. It is especially hard during dialysis days because we need him to be awake and ready for the procedure. In the beginning of dialysis he was more spirited and lively. Now he looks exhausted and somewhat frustrated to deal with his illness. All he wants is rest and sleep. I feel like he wants to do more activities but his body and mind seems tired. He has also become more impatient. This week his IBC level is 18%. They say it is considered low. My question; is his excessive fatigue due to physiological conditions aside from his IBC level and physical illness? Is there any fatigue management that I can follow and educate myself and family members to improve his quality of life? How to deal with his emotions? The health care facility here seems to not really address the fatigue and emotional conditions of dialysis patients. I would really appreciate your advice. Looking forward to your response doctor, thank you very much. Regards.

The standard treatment for End Stage Kidney Disease (ESKD) is three times per week dialysis. It may be that he is not getting sufficient dialysis to keep his blood chemistry’s stable. He may need more dialysis. A low Iron Binding … Continue reading

Posted in Anemia, Ask the Doctor, Blood/Urine Testing For Kidney Disease, Chronic Kidney Disease, Dialysis, Kidney-Related Health Questions, Nephrologist

I am a SLE patient with chronic anemia issues, edema and hypertension. My most recent labs in August showed my gfr had dropped to 55. It was 70 in March. Could I be developing Lupus Nephritis?

Lupus nephritis may occur in patients with systemic lupus erythematosus (SLE).  Your physician would need to do testing to specifically diagnose nephritis.  This testing should include urine and blood testing.

Posted in Anemia, Ask the Doctor, Chronic Kidney Disease, GFR, Kidney-Related Health Questions, Lupus, Symptoms and Side Effects, Treatments

I have one kidney, Stage 3 ckd and Crohn’s disease. History of kidney stones. This summer I’ve been drinking diet tonic water with lime several times daily but recently heard quinine might not be good for my kidney. Is it safe for me to consume diet tonic water?

Quinine has been associated with hemolytic anemia but I am not aware of any kidney toxicity.  All drugs may rarely be associated with allergic reactions in the kidney.  Tonic water contains only a very small amount of quinine and should … Continue reading

Posted in Anemia, Ask the Doctor, Chronic Kidney Disease, Diet/Nutrition, Kidney-Related Health Questions, Treatments

My father is aged about 66 years; had been suffering from diabetes and hypertension for the last fifteen years. He has been diagnosed and suffering from Diabetic Nephropathy. The Biopsy Report says “Shows renal tissue with 14 glomeruli, 3 are globally sclerosed. Glomerular compartment: Diffuse intercapillary mesangial matrix expansion, mild mesangial hypercellularity, paramesangial capillary wall thickening and narrowing of lumina. One glomerulus show ischemic tuft atrophy with dilatation of the Bowman’s space and capsular fibrosis. Extra glomerular compartment: Interstitial expansion with mild infiltrates of mononuclear cells. Focal tubular atrophy. IFTA <5%. Vascular compartment: Arteriolosclerosis and arteriosclerosis" His latest reports are: Hemoglobin: 9.2g / dL HbA1c: 4.8% Serum Urea Nitrogen: 13.5 mg/ dL Serum Creatinine: 0.8 mg/ dL Serum Sodium: 135 mEq/ L Serum Potassium: 5 mEq/ L Serum Chloride: 105.5 mEq/ L Total Protein: 5 g/ dL Total Albumin: 2.6 g/ dL Serum Globulin: 2.4 g/dL A/G Ratio: 1.1 25-OH Vitamin D Total: 18.5 ng/mL eGFR: 93.1 ml/min/1.73 sq min He has primarily been advised the following medicines by the Nephrologist: 1. ACE Inhibitors (Enalapril) 2. Calcium Channel Blocker (Cilnidipine) 3. Torsemide, if required 4. Aspirin Tab 5. Tenepride M Tab 6. Rosuvastatin Tab 7. Nexiron LP Tab 8. Logical Tab 9. Ferronemia Tab 10. Remylin D Tab His Urine Albumin/ Creatinine Ratio is 3047 mg/g. I just wanted to know whether the prescribed medicines are the best which can be given to him? Are there any chances of controlling proteinuria with the combination of ACE Inhibitors and Calcium Channel Blockers or should we try ACE Inhibitors and ARBs? We just want to slow down his renal deterioration and your valuable guidance is deeply solicited in this regard. Looking forward with high hopes.

I do not recommend the combination of an ACE-inhibitor and an ARB agent. This is not a good combination. I will assume that the Remylin D contains vitamin D that he is taking for a vitamin supplement. His vitamin D … Continue reading

Posted in Anemia, Ask the Doctor, Blood/Urine Testing For Kidney Disease, Diet/Nutrition, Hypertension/High Blood Pressure, Kidney-Related Health Questions

Can anemia be treated with iron shots instead of EPO? I’m concerned about the side effects from the synthetic hormone. Are other treatments available?

Anemia in patients with chronic kidney disease (CKD) should be treated first with iron, if the patient is iron deficient. Once iron deficiency is treated, then drugs such as erythropoietin (EPO) can be used. There are some study drugs that … Continue reading

Posted in Anemia, Ask the Doctor, Chronic Kidney Disease, Clinical Trials/Studies, Kidney-Related Health Questions

I have been on a trial for Roxadustat for 8 years. On March 3, 2019, I was taken off the study after my platelets dropped from 95 to 20. I asked to return to the study after my platelets returned to 89. I am currently in late stage 4 CKD bordering ESRD. GFR 22, HgB 8.5, Creatinine 2.7 I have been having CBC’s every month for the past 3 years. Until the platelets dropped for unknown reasons, Roxadustat maintained my HgB at between 11 and 12. My Nephrologist and Hematologist tried steroids (Prednisone) to try and increase my platelets, which was not effective. We tried a homeopathic remedy of Vitamin K and that brought the readings back up to where they had been before the drop. I am trying to get access to Roxadustat for compassionate use, as my Hgb is now declining more rapidly and my nephrologist agrees that it was effective, but the administrator of the drug trial lab has been reluctant to restart me and says the study will be ending in September anyway. I was diagnosed with stage 3 CKD in 2010 and was informed then that I would likely be on dialysis within 2 years at the rate my kidneys were declining. I got on the Roxadustat trial first for a 27 week study in 2010. That study ended in December 2010 and then I got on an extended study which lasted until March 2019. I have avoided dialysis and having seen the statistics etc. do not plan on either type. I have been told by several Doctors that I am not a good candidate for Procrit or Aranesp due to inflammation diseases I have. My Neprologist has told me that transfusion is an option. I have thought seriously about traveling to China where Roxadustat is approved by the China FDA for use with dialysis patients and is expecting to be approved for non-dialysis very soon. Any suggestions?

There are a number of other anemia drugs that have trials other than Roxadustat. I am familiar with Daprodustat and Vadadustat and there are others. You may be able to find other trails that are available for other drugs. You … Continue reading

Posted in Anemia, Ask the Doctor, Chronic Kidney Disease, Clinical Trials/Studies, Kidney-Related Health Questions, Nephrologist, Transplantation

I recently asked about my blood work-up results affecting my surviving kidney. I apologize for all of the acronyms used in previous question and appreciate your answer. I will re-ask with no abbreviations, only to possibly help someone else with the answer you give. I had a radical nephrectomy (RN) last year, due to Upper Tract Urothelial Carcinoma (UTUC). That cancer seeded into bladder and ended up having 3 malignant tumors removed by transurethral resection of bladder tumor (TURBT). I had another resection done recently to biopsy the bladder again and hemorrhaged 16 days later. They had to surgically stop the blood loss and remove clots in the bladder. They also did a pyelogram on surviving kidney to make sure blood wasn’t coming from there. I had cbc done during hospital stay and a week later. All showed low red blood cell count (2.37), low hematocrit (24.7) and hemoglobin (7.8). My gfr is 58. I have no heart issues that I am aware of. My blood pressure has been sporadic. Of course after the trauma of hemorrhage it was 80/42 all night but it has been ranging 132/62 to 130/92. I don’t have a nephrologist as my urologist is doing periodic diagnostics to make sure the cancer hasn’t come back to the surviving kidney so I am curious if the trauma from this incident and low blood work would affect my one kidney and is a 58 eGFR something to be concerned about? Thank you SO much for taking the time you do to answer questions for people. We ALL appreciate the time you put in!

With a single kidney, your estimated glomerular filtration rate (eGFR) would be expected to be in the range of 50 to 70 milliliters per minute per 1.73 meters squared. This would be expected if your remaining kidney was normal. The … Continue reading

Posted in Anemia, Ask the Doctor, GFR, Kidney-Related Health Questions, Nephrectomy / One kidney