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K
Spot Dx
60/F with 3-month tiredness, pallor, and high blood pressure
Nephrology
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Case Presentation
A 60-year-old female presents with a 3-month history of progressive tiredness and generalized itching. She has a long-standing history of hypertension which she manages inconsistently with herbal remedies. On examination, she has marked conjunctival pallor and her blood pressure is 175/105 mmHg. Laboratory tests reveal a hemoglobin of 8.2 g/dL, a serum creatinine of 450 µmol/L (4.9 mg/dL), and proteinuria 3+ on dipstick.
Question
What is the most likely diagnosis, and what physiological mechanism explains her anemia?
Answer
The diagnosis is Chronic Kidney Disease (CKD), likely stage 4 or 5. The anemia is primarily caused by the failure of the diseased kidneys to produce sufficient erythropoietin, which is necessary to stimulate red blood cell production in the bone marrow.
Clinical Pearl
Chronic Kidney Disease is a silent killer; normochromic normocytic anemia and resistant hypertension in a middle-aged patient are hallmark signs of advanced renal parenchymal disease.