Question

A patient with chronic kidney disease is at risk for anemia. Arrange the events in the order in which they lead to anemia caused by chronic kidney disease.

A. Bone marrow fibrosis
B. Elevated levels of parathyroid hormone (PTH)
C. Inhibition of erythropoiesis
D. Shortened survival of red blood cells (RBCs)

Answer 1

Anemia in chronic kidney disease is primarily caused by inhibition of erythropoiesis due to decreased EPO synthesis, followed by elevated levels of PTH leading to bone marrow fibrosis, and finally, a shortened survival of red blood cells.

Step-by-step explanation:

A patient with chronic kidney disease (CKD) is at risk for anemia due to several factors that occur in sequence. First, the diseased kidneys produce less erythropoietin (EPO), a hormone essential for the production of red blood cells. Without sufficient EPO, the bone marrow's production of red blood cells is reduced, leading to anemia.

1. Inhibition of erythropoiesis due to decreased EPO synthesis.
2. Elevated levels of parathyroid hormone (PTH) may contribute to bone marrow fibrosis and alterations in iron metabolism, hindering red blood cell production.
3. Bone marrow fibrosis occurs as a result of the elevated PTH, leading to a further decrease in the production of red blood cells.
4. There is also a shortened survival of red blood cells (RBCs), adding to the severity of anemia in CKD.