Question

Anaemia of advanced renal insufficiency is best treated by

• A. Blood transfusions
• B. Recombinant human erythropoietin
• C. Parenteral iron therapy
• D. Folic acid

Hint:

Think about which hormone the failing kidney stops producing in adequate amounts.

Answer 1

The Correct Option is B

Step 1: Understanding the Question:
The question is about the preferred treatment for the anaemia that develops in patients with advanced kidney disease, a very common clinical problem in nephrology practice.

Step 2: Key Concept or Approach:
The anaemia of chronic kidney disease occurs mainly because the failing kidneys lose their ability to produce erythropoietin, the hormone that signals the bone marrow to make red cells. Correcting a hormone deficiency is best done by replacing that hormone rather than by treating downstream symptoms alone.

Step 3: Working Through the Options:
Blood transfusions raise haemoglobin quickly but carry risks of iron overload, sensitisation against a future transplant, and transfusion-related infection, so they are reserved for urgent or refractory cases, not first-line therapy. Parenteral iron therapy alone does not fix the underlying erythropoietin deficiency, though adequate iron stores are needed for erythropoietin to work well. Folic acid corrects megaloblastic anaemia from folate deficiency, which is not the mechanism operating here. Recombinant human erythropoietin directly replaces the missing hormone, stimulating the bone marrow to produce red cells, and is the standard, most effective treatment for this anaemia.

Step 4: Conclusion:
The correct answer is recombinant human erythropoietin, since it treats the actual cause, erythropoietin deficiency, rather than just supplementing red cells or haematinics.