Tsagalis G
Renal Unit, Alexandra Hospital, Athens, Greece.
Hippokratia. 2011 Jan;15(Suppl 1):39-43.
Anemia is a common finding in patients with CKD, with a prevalence that increases gradually as eGFR declines. The prevalence of renal anemia depends on the size of the study and the selection of participants. Diabetic status increases the prevalence of anemia in patients with CKD. Anemia in CKD is due primarily to reduced production of erythropoietin in the kidney and secondarily to shortened red cell survival. Erythropoeitin (EPO) is produced by peritubular cells in the kidneys of the adult and in hepatocytes in the fetus. These cells are sensitive to hypoxia that once sensed leads to an increase in EPO production. EPO circulates in the plasma and induces redcell production in the bone marrow after successful binding to erythroid progenitor cells. Apart from EPO, folate, B(12) and iron are needed to assure effective erythropoiesis. Factors that can dysregulate this process include inflammation, uremic toxins, hypothyroidism, hypersplenism and ongoing infection.The investigation of renal anemia requires the assessment of a variety of biological indices. Among them, the complete blood count, the reticulocyte index, B(12), folate, ferritin levels and the saturation of transferrin are the most valuable tools in revealing the cause of renal anemia.
贫血是慢性肾脏病患者的常见表现，其患病率随估算肾小球滤过率（eGFR）下降而逐渐升高。肾性贫血的患病率取决于研究规模和参与者的选择。糖尿病状态会增加慢性肾脏病患者贫血的患病率。慢性肾脏病中的贫血主要是由于肾脏中促红细胞生成素生成减少，其次是由于红细胞存活时间缩短。促红细胞生成素（EPO）由成人肾脏中的肾小管周围细胞和胎儿肝脏中的肝细胞产生。这些细胞对缺氧敏感，一旦感知到缺氧就会导致EPO生成增加。EPO在血浆中循环，与红系祖细胞成功结合后诱导骨髓中的红细胞生成。除EPO外，还需要叶酸、维生素B12和铁来确保有效的红细胞生成。可使这一过程失调的因素包括炎症、尿毒症毒素、甲状腺功能减退、脾功能亢进和持续感染。肾性贫血的检查需要评估多种生物学指标。其中，全血细胞计数、网织红细胞指数、维生素B12、叶酸、铁蛋白水平和转铁蛋白饱和度是揭示肾性贫血病因最有价值的工具。
