[Renal anemia. Its diagnosis, pathogenesis, compensation and therapy in childhood].

Based on extensive own investigations of a great number of pediatric patients with chronic renal failure at the University Children's Hospital of Heidelberg, renal anemia is reviewed. After the demonstration of its clinical importance, its intensity depending on the mode of treatment (conservative therapy, regular dialysis, renal transplantation), and its diagnostic characteristics, an analysis of the three most important pathomechanisms is given: bone marrow hypoplasia, increased hemolysis and chronic blood loss. These pathomechanisms influence each other, are the result of multifactorially acting uremic toxins and can additionally be potentiated by iron-, folate-, and vitamin B12-deficiency. The hematologic mechanisms to compensate renal anemia are insufficient: first the indirect way, because the increase in erythrocyte organic phosphates is insufficient and the shift of the hemoglobin oxygen dissociation curve to the right is inadequate, second the direct way because erythropoietin is secreted inadequately. After description of the diagnostic paramenters for long-term care of renal anemia therapeutic recommendations are given with respect to each stage of treatment.