Renal disease anemia with, treatment

Erythropoietin [ery throw PO eetin] is a glycoprotein, normally made by the kidney, that regulates red cell proliferation and differentiation in bone marrow. Human erythropoietin, produced by recombinant DNA technology, is effective in the treatment of anemia caused by end-stage renal disease, anemia associated with HIV-infected patients, and anemia in some cancer patients. Supplementation with iron may be required to assure an adequate response. The protein is usually administered intravenously in renal dialysis patients, but in others the subcutaneous route is preferred. Side effects such as iron deficiency and an elevation in blood pressure occur. [Note The latter may be due to increases in peripheral vascular resistance and/or blood viscosity.]... 

Erythropoietin (Eprex ) is physiologically produced in the kidney and regulates proliferation of committed progenitors of red blood cells. It is used to substitute erythropoietin in severe anemias due to end stage renal disease or treatment of cancer with cytostatic agents. Side effects include hypertension and increased risk of thrombosis. 

Treatment of anemia associated with chronic renal failure (CRF) n adults and children 1 month of age and older, treatment of anemia associated with CRF, including patients on dialysis (end-stage renal disease) and patients not on dialysis, to elevate or maintain the red blood cell level (as manifested by the hematocrit or hemoglobin determinations) and to decrease the need for transfusions. Nondialysis patients with symptomatic anemia considered for therapy should have a hemoglobin less than 10 g/dL. Not intended for patients who require immediate correction of... 

Parenteral therapy should be reserved for patients with documented iron deficiency who are unable to tolerate or absorb oral iron and for patients with extensive chronic anemia who cannot be maintained with oral iron alone. This includes patients with advanced chronic renal disease requiring hemodialysis and treatment with erythropoietin, various postgastrectomy conditions and previous small bowel resection, inflammatory bowel disease involving the proximal small bowel, and malabsorption syndromes. 

In 2003, the leading orphan drag by worldwide sales revenue was Amgen s erythropoetin (Epogen), with US sales of 3.2 billion. It obtained orphan drag status for treatment of anemia associated with azidothymidine (AZT) therapy, prematurity and end stage renal disease in both dialyzed and non-dialyzed patients. 

Control of anemia with darbepoetin alfa has been reported in association with cancer chemotherapy, treatment of renal insufficiency, to control anemia due to inflammatory bowel disease, and in diabetes-induced anemia. However, this appears to be the first time it has been used successfully to control a drug-induced anemia. 

Fluid retention may occur, perhaps as a result of peripheral vasodilation and/or improved insulin sensitization with a resultant increase in renal sodium and water retention. A dilutional anemia may result, which does not require treatment. Edema is reported in 4% to 5% of patients when glitazones are used alone or with other oral agents. When used in combination with insulin, the incidence of edema is about 15%. Glitazones are contraindicated in patients with New York Heart Association Class III and IV heart failure and should be used with great caution in patients with Class I or II heart failure or other underlying cardiac disease. 

Phenylbutazone (Butazolidin) is metabolized to oxy-phenbutazone (Phlogistol), and both compounds have all of the activities associated with the NSAIDs. Their use is accompanied by serious adverse reactions, such as anemia, nephritis, renal failure or necrosis, and liver damage. Because of their toxicity, they are prescribed only for the treatment of pain associated with gout or phlebitis or as a last resort for other painful inflammatory diseases resistant to newer and less toxic treatments. Interactions with a large number of other drugs... 

Adverse effects Colchicine treatment may cause nausea, vomiting, abdominal pain, and diarrhea (Figure 39.15). Chronic administration may lead to myopathy, agranulocytosis, aplastic anemia, and alopecia. The drug should not be used in pregnancy, and should be used with caution in patients with hepatic, renal or cardiovascular disease. 

Oxymetholone, an anabolic steroid (1 to 5 mg/kg/day), is indicated for the treatment of anemias caused by deficient red cell production, acquired or congenital aplastic anemia, myelofibrosis, and hypoplastic anemias due to the administration of myelotoxic drugs. Oxymetholone stimulates the kidney production of erythropoietin, leading to increases in red blood cell number, mass, and volume (see also Figure 44). Oxymetholone is contraindicated in patients with severe renal or cardiac disease, which may be worsened by the fluid and electrolyte retention, and in patients with prostatic hypertrophy with obstruction or prostatic cancer. The side effects associated with anabolic steroids include cholestatic jaundice, prepubertal phallic... 

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