Question

A 35-year-old man with known stage 3 chronic kidney disease due to diabetes presents with fatigue. His blood sugars are acceptable; his mood is euthymic, and he is sleeping and eating well. He does not smoke, and he has no known toxic environmental exposures. Work up shows normochromic normocytic anemia, with a hemoglobin of 11 g/dl, which is decreased from 12 g/dl 6 months ago. Medications include lisinopril, furosemide, and insulin.

Iron 50 ug/dl (normal 50-150 ug/dl)
Ferritin 200 ng/ml
Ratio soluble transferrin receptor/log ferritin Reduced
Reticulocytes 0.25%
Platelets Normal
Total white blood cell count 5x103/mm3
B12 levels, serum Normal

What is the most likely diagnosis?

Answer 1

The 35-year-old man with stage 3 chronic kidney disease and fatigue, exhibiting normochromic normocytic anemia with laboratory findings consistent with functional iron deficiency, is most likely diagnosed with anemia of chronic disease (ACD).

Step-by-step explanation:

The most likely diagnosis for a 35-year-old man with known stage 3 chronic kidney disease (CKD) due to diabetes, who presents with fatigue, normochromic normocytic anemia with a hemoglobin of 11 g/dl, and other normal lab values (including Iron and B12 levels), is anemia of chronic disease (ACD) or anemia of inflammation. This type of anemia is commonly associated with chronic illnesses such as CKD. In this context, the reduced ratio of soluble transferrin receptor to log ferritin also supports the diagnosis of ACD, as it typically signifies a functional iron deficiency within the context of chronic inflammation or disease rather than true iron deficiency anemia. The fact that the patient's iron levels are on the lower end of normal but ferritin, an acute phase reactant, is elevated, further supports this diagnosis.