Renal anemia

Chronic kidney disease: renal anemia

Anemia is one of the most prevailing complications of chronic renal failure. Symptoms such as fatigue, anorexia, concentration problems and dyspnea are often caused by the anemia. Normochrome, normocellular anemia is due to the decreased production of erythropoietin (EPO) by the kidneys. The peptide hormone EPO is normally produced by the kidneys upon low oxygen levels and low blood pressure in the kidney tissue. The kidneys produce 90% of the total EPO amounts; the liver also contributes with 10% of the EPO production.

In CRF patients, the production of EPO is decreased because of the loss of renal cells producing EPO. EPO stimulates the red blood cell production in the bone marrow by differentiation and proliferation and thus also increases the blood volume. More in detail, EPO is responsible for the stimulation of cell division rates in erythroblasts and stem cells that produce erythroblasts and the acceleration of the red blood cell maturation, mainly the rate of hemoglobin synthesis.


Anemia in the setting of acute renal failure is very common and usually multifactorial. Which of the following is NOT a cause?