Anemia

Abstract

A 32-year-old man with a history of diabetes mellitus type I and chronic kidney disease (CKD) stage V presents to the nephrology clinic after 1 year of being lost to follow-up, complaining of increasing edema of 1 month duration. His past medical history includes diabetes mellitus type I for 12 years, diabetic retinopathy, hypertension, and anemia. Medications include insulin, furosemide, and amlodipine. The patient reports rare alcohol use and no smoking or drug use. His family history includes diabetes mellitus and hypertension. Physical exam includes a blood pressure of 150/90. There is 2+ bilateral lower extremity edema extending to his knees. His creatinine is 10.6 mg/dL with an eGFR (estimated glomerular filtration rate) of 7 mL/min. His eGFR was below 15 mL/min 1 year ago. His hemoglobin a year ago was 10.6 g/dL; currently, the hemoglobin is 7.6 g/dL and hematocrit of 23. Other labs include a serum iron level of 76 mcg/dL, total iron binding capacity (TIBC) of 217 mcg/dL, iron saturation of 35 %, total serum ferritin level of 207 ng/mL, a reticulocyte production index of 0.7, a parathyroid hormone level of 220 pg/mL, and a hemoglobin A1C of 7.3 %. What should be included in the work-up for patients with CKD who present with anemia? What are possible causes for the anemia?