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“Out of Sight, Out of Mind”: The Failed Renal Allograft as a Cause of ESA Resistance

Approximately 10% of patients treated with erythropoiesis‐stimulating agents (ESAs) for the anemia of chronic kidney disease are unresponsive or relatively resistant to therapy. The etiology of this is usually linked to iron deficiency or an independent underlying illness. We describe a hemodialysis...

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Detalles Bibliográficos
Autores principales: Mehrotra, Anita, Tan, Judy A., Ames, Scott A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560621/
https://www.ncbi.nlm.nih.gov/pubmed/26096871
http://dx.doi.org/10.1111/sdi.12401
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author Mehrotra, Anita
Tan, Judy A.
Ames, Scott A.
author_facet Mehrotra, Anita
Tan, Judy A.
Ames, Scott A.
author_sort Mehrotra, Anita
collection PubMed
description Approximately 10% of patients treated with erythropoiesis‐stimulating agents (ESAs) for the anemia of chronic kidney disease are unresponsive or relatively resistant to therapy. The etiology of this is usually linked to iron deficiency or an independent underlying illness. We describe a hemodialysis patient with a failed renal transplant 1.5 years earlier, who developed progressive erythropoietin resistance and anemia without an apparent cause. He simultaneously developed nonspecific malaise and fatigue. By exclusion, the only possible cause of these signs and symptoms was inflammation from acute and chronic rejection in the retained failed renal allograft. Following pulse steroids and transplant nephrectomy, the patient's symptoms resolved and both his hemoglobin improved and his erythropoietin requirements decreased significantly. The patient never required a blood transfusion and was successfully relisted for a deceased donor renal transplant. Hence, inflammation from a retained transplant allograft may be an under‐recognized cause of erythropoietin resistance in dialysis patients. Although transplant nephrectomy remains a controversial practice due to concerns of alloantibody production, it may be considered in patients with failed renal allografts and anemia refractory to treatment with ESAs.
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spelling pubmed-45606212016-02-18 “Out of Sight, Out of Mind”: The Failed Renal Allograft as a Cause of ESA Resistance Mehrotra, Anita Tan, Judy A. Ames, Scott A. Semin Dial Dialysis Rounds Approximately 10% of patients treated with erythropoiesis‐stimulating agents (ESAs) for the anemia of chronic kidney disease are unresponsive or relatively resistant to therapy. The etiology of this is usually linked to iron deficiency or an independent underlying illness. We describe a hemodialysis patient with a failed renal transplant 1.5 years earlier, who developed progressive erythropoietin resistance and anemia without an apparent cause. He simultaneously developed nonspecific malaise and fatigue. By exclusion, the only possible cause of these signs and symptoms was inflammation from acute and chronic rejection in the retained failed renal allograft. Following pulse steroids and transplant nephrectomy, the patient's symptoms resolved and both his hemoglobin improved and his erythropoietin requirements decreased significantly. The patient never required a blood transfusion and was successfully relisted for a deceased donor renal transplant. Hence, inflammation from a retained transplant allograft may be an under‐recognized cause of erythropoietin resistance in dialysis patients. Although transplant nephrectomy remains a controversial practice due to concerns of alloantibody production, it may be considered in patients with failed renal allografts and anemia refractory to treatment with ESAs. John Wiley and Sons Inc. 2015-06-21 2015-09 /pmc/articles/PMC4560621/ /pubmed/26096871 http://dx.doi.org/10.1111/sdi.12401 Text en © 2015 The Authors. Seminars in Dialysis published by Wiley Periodicals, Inc. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Dialysis Rounds
Mehrotra, Anita
Tan, Judy A.
Ames, Scott A.
“Out of Sight, Out of Mind”: The Failed Renal Allograft as a Cause of ESA Resistance
title “Out of Sight, Out of Mind”: The Failed Renal Allograft as a Cause of ESA Resistance
title_full “Out of Sight, Out of Mind”: The Failed Renal Allograft as a Cause of ESA Resistance
title_fullStr “Out of Sight, Out of Mind”: The Failed Renal Allograft as a Cause of ESA Resistance
title_full_unstemmed “Out of Sight, Out of Mind”: The Failed Renal Allograft as a Cause of ESA Resistance
title_short “Out of Sight, Out of Mind”: The Failed Renal Allograft as a Cause of ESA Resistance
title_sort “out of sight, out of mind”: the failed renal allograft as a cause of esa resistance
topic Dialysis Rounds
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4560621/
https://www.ncbi.nlm.nih.gov/pubmed/26096871
http://dx.doi.org/10.1111/sdi.12401
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