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- Anemia in Kidney Disease
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- jessieann30
- Message 1 of 6 , May 22, 2014
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- Hi all,
- I have a patient with auto-immune kidney disease. Her kidney function has been stable if not slightly improving with treatment, however recently her anemia has worsened recently. About 3 months ago she stopped twice monthly EPO injections because her Hgb was high and she was experiencing HTN. Her iron stores are high- ferritin 531 (15-300), Iron 31 (9-32), TIBC 34 (33-78), Iron sat index 0.91 (0.15-0.45)
- Her RCB 3.1 (3.7-5.0), Hgb 96 (118-151), hct 0.28 (0.33-0.45), MCV 90.3, rdw 14.9.
- I am assuming that this must be the kidney's inability to stimulate RBC production since her iron stores are high. I have had great success increasing Hgb with a yellow dock/nettle/molasses syrup, but I am concerned this just provides iron which she doesn't really need. Do you think it will help anyway? Do we know and specific EPO stimulators besides drugs?
- thanks for any thoughts,
- Jessie Speirs ND
- Winlaw, BC
- Emily Kane
- Message 2 of 6 , May 22, 2014
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- this is rare, but she may be suffering RBC destruction because of a kidney irritant. Oxalates come to mind. She could either try a low oxalate diet for 4-6 weeks or have a kidney biopsy to assess oxalate nephropathy. You could run this idea by her nephrologist.
- Emily Kane ND
- Juneau AK
- www.DrEmilyKane.com
- www.ThisIsOrenda.com
- www.naturopathic.org
- "Let your highest aspiration organize your life."
- Jena
- Message 3 of 6 , May 22, 2014
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- Emily
- Would you see high oxalates in urine in that case? Or just biopsy?
- Thanks
- Jena Peterson ND
- Seattle
- Sent from my iPhone
- Emily Kane
- Message 4 of 6 , May 22, 2014
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- Oh! great question -- but don't you know the answer :)
- My dad (a celiac) went into chronic kidney failure after a complicated cardiac surgery and got EPO for awhile but it was hideously expensive and didn't really do much for his anemia. His skin was starting to fall apart. Pruritic, paper thin and friable. I'm not sure urine was checked for oxalates but his creatinine get going up and his eGFR kept going down. The nephrologist recommended a biopsy which I thought seemed drastic, but that's where the oxalate "allergy" was discovered and getting on a very low oxalate diet has helped his skin, mood and kidney parameters more than anything else.
- Emily Kane ND LAc
- Juneau AK
- www.DrEmilyKane.com
- www.ThisIsOrenda.com
- www.naturopathic.org
- "Let your highest aspiration organize your life."
- Daniel H. Chong
- Message 5 of 6 , May 22, 2014
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- Just in case, I'd check her testosterone levels:
- http://ndt.oxfordjournals.org/content/early/2011/05/26/ndt.gfr288.full
- http://www.ncbi.nlm.nih.gov/pubmed/21748720
- --
- Aloha,
- Daniel Chong, ND
- DrDanielChong.com
- richardmaliknd
- Message 6 of 6 , May 23, 2014
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- Hi Jessie,
- I would agree with your suspicion that the syrup is essentially an iron supplement.
- To support EPO, I would be looking for ways of supporting / preserving kidney function.
- If kidney inflammation is compromising kidney function, I would consider Longvida Curcumin, Boswellia, or other kidney-gentle anti-inflammatory approaches. Whatever basics can be done to decrease auto-immunity might also be a good idea (i.e. avoidance of foods contributing to immune response, probiotics, fish oil, maintaining 25-OH vitamin D at 40 ng/mL, monitor 1,25 OH vitamin D for normal levels).
- To support kidney function, I would consider Ayush Rentone, Coenzyme Q10, and Acetyl-L-Carnitine.
- I agree with Dr. Chong about checking testosterone - it could be used to elevated HCT. This would be a reasonable but aggressive consideration because, in my experience, only high-doses of testosterone have this effect.
- I hope this helps. Good luck.
- Richard Malik, ND
- Salisbury, CT
- Manchester Center, VT
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