Q. 376. Who is the 1st physician declares the renal relation to anemia?
"Erythropoietin therapy"
Q. 376. Who is the 1st physician declares the renal relation to anemia?
A. Richard
Bright, 1836🠞1st said “After a time the
healthy color of the countenance ملامح الوجه fades”.
Q. 377. Then What?
A. In 1970 & 1980🠞Ischbach &
Adamson 🠞Pioneer
work : Epo
defined as 👉responsible
of renal anemia.
- In 1985 🠞Isolation
of the native Epo. gene, by “Lin
& colleague”.
- In 1986🠞r.HuEpo (recombinant human Epo.) colonizing🠞“Chinese hamster” ovary cell.
Q.378. In which site in the kidney Epo.
is secreted?
A. Two sites: ✌
Q.379. What are the recent K/DOQI guidelines as regard R. anemia?
* Start Epo
thpy at level of 🠞11-13 g/dl.
* Highest
threshold 🠞<
13.5 g/dl
in adult male.
* Highest
threshold 🠞<
11.5 - 12 g/dl in
adult female.
Q.380. What is the baseline workup for R. anemia according to recent K/DOQI? 👈
A. Baseline workup for R. anemia 🠊Hemogram: {Erythrocyte
indices, Retics , TSAT, S. ferritin, occult blood in stool &
either: % hypochromic erythrocytes, or Retics H.B. content}.
Q.381. What are the different forms of Epo
?
A. Epo. forms :
1) Epo a (Ebrex) &
B (Recormon) (165
a.a.)🠊Glycoprotein produced
thr. recombination of the human Epo gene within “Chinese hamster ovary”
cells.The B form àmore
basic (Sialic a.)🠊
higher in Vivo/Vitro activity. It is larger in volume of distribution, 20 % longer t.½ é i.v.
route, delayed more é s.c. route compared to Epoa.
2) Omega:
rHuEpo 🠊produced by baby hamster kidney, é slight hydrophilic ch. ch.
3) Delta:
rHuEpo🠊produced by human cell engineering to translocate the gene.
4) Pegylated form of erythropoietic stimulating f.🠊Continuous
Erythrocyte Receptor Stimulation, FDA approved.
Sialc a. & CHO 🠊🠝Duration
of action.
5) Hyperglycosylated(rHuEpo) analogue é 5
N-linked CHO chains(rHuEpo hs 3) designed in 1990 as [Darbepoietin alfa], “Aranesp”(Novel
Erythro-poiesis-Stimulating Protein) NESP. Depo &
rHuEpo 🠊same
mch. & intra-cellular signaling.
Q.382. How can you assist Epo resistance (failure of therapy or poor response)? (see also Q. 396).
A. Resistance to Epo
cn be related to the following:
1) P.H.
2) Differental WBCs (Infection) .
3) Water
soluble vitamin deficiency.
4) Hemolytic
status.
5) Paraproteinemia.
6) Aliminum intoxication.
7) High
bone turnover.
Q.383 What are the adverse effects of Epo therapy?
A. Adverse effects of Epo therapy:
1) Worsening of H.T. (occur accelerated) due
to :
i. 🠝P.R.
ii. 🠝RBCs mass.
iii. Loss of V.D. effect of anemia.
2) Seizures (not
a C.I. for Epo.).
3) Impaired solute clearance, especially👉K+ 🠞Hyperkalemia & azotemia.
4) Increased
frequency of thrombotic events at, but not confined
to, vascular access, esp. é H.B. >13 g/dl.
5) Icreased. incidence of cancer
recuurence.
Q.384. Give the dose & route
of Epo?
A. Initial
dose of darbepoietin a (Dpo)🠊Pre. D.X. 🠞0.45 mcg/kg/w.
&
Initial dose of (Dpo) for
HDX. Ptn.🠊0.75 mcg/kg/w.
* Dose of rHuEpo 🠊(80-120) u/kg/w.
for
s.c. route
(120-180) u/kg/w. for i.v. route
- “Europian”
recommended 🠊(50-150) u/kg/w. s.c.
& i.v.
- “Canadian”
recommended🠊(100-200) u/kg/w. s.c.
& i.v.
- I.P. (intraperitoneal
route)🠊Dry
abdomen or minimal Dzt.
- Suggested
SAFE rate of correction of anemia 🠊1-2 g/dl/m. ≤ 2-3 g/dl/m.
- Slow response to rHuEpo🠊Increased dose by 25-50 % & by 25 % é rapid rise of B.P.
- Measure H.B. Biweekly
at the start then monthly.
- Iron profile /3 monthly, if
erythropoiesis is stable.
Q.385. Why does the B.P. increase é Epo therpy?
A. Two ✌main reasons:
I. Incr. RBCs mass 🠞🠝 P.R.
II. Incr. “vascular reactivity”, due to: 👌
(1) 🠟 N.O.
production 🠞Loss of its V.D. effect.
(2) Release of Endothelin
& V.C. protanoids 🠞increased Cytosolic Ca+.
(3) Trophic effect of Epo on endothelial cell
growth.
Q.386.What is the role of oral Iron
in ttt. of anemia in H. DX. patient?
A. Pooooor, 😌😌😌 why? :
1. Poor compliance, due to G.I. upset, two cp./d at
least, poor education.
2. Poor efficacy, need to be taken é empty
stomach, poor absorption.
3. Poor absorption: Po4
binders interfere é iron absorption.
(Ca acetate 27%- Ca Hco3. 19% - Sevelamer Hcl 10%)
**
Oral iron can only be used in: 1.
P.D. 2.
Pre-DX. … as much
less
iron losses.
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