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a patient is undergoing dialysis for renal failure starts receiving erythropoietin. He has a history of Type 1 DM, HTN (which is controlled) and peripheral neuropathy. Which of the following will be exacerbated in this patient??
A. Chronic renal insufficiency
B. Diabetes Mellitus
C. HTN
D. Osteitis Fibrosa Cystica
E. Peripheral Neuropathy
Can u guys answer this one 4 for me and give an explanation for your answer??
Thanks
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peripheral neuropathy
as need to supplement folic acid to prevent macrocytic anaemia
pali
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hypertension as erythropoeitin will stimulate erythropoesis and it will increase the blood volume and hematocrit.
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i was thinking HTN too.....
any other replies???
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The most important complications in patients treated with erythropoietin include: hypertensive reactions; thrombosis of AV fistula in patients on hemodialysis and appearance of severe anemia as a part of Pure Red Cell Aplasia (PRCA).
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HTN is the most common complication actually
there is an entire article in uptodate about "Hypertension following erythropoietin in chronic renal failure"
here's a part of it
INTRODUCTION ” Approximately 20 to 30 percent of patients who receive erythropoietin (EPO) intravenously for the anemia of chronic renal failure may develop an elevation in diastolic pressure of 10 mmHg or more [1,2]. In comparison, the blood pressure (BP) is less likely to rise after subcutaneous administration [3].
PATHOGENESIS ” How EPO therapy may raise the blood pressure is not well understood [4]. Several factors have been identified that may contribute to the hypertensive response. These include the following [4-14]: High dose of EPO Rapid increase in hemoglobin/hematocrit Direct vasoconstrictive effect Large absolute elevation in hemoglobin/hematocrit Diminished response to nitric oxide Marked increase in intracytosolic calcium levels Enhanced responsiveness to norepinephrine Increased plasma endothelin levels, although some studies have not replicated this observation Arterial remodeling through simulation of vascular cell growth Increase in whole blood viscosity Prior personal or family history of hypertension
