Renal Anemia

By | June 8, 2022

Renal anemia is kidney-related anemia that can be attributed to disorders of erythropoiesis (synthesis of red blood cells) caused by renal insufficiency. The extent of renal anemia depends on the severity of the underlying renal insufficiency. Renal anemia can usually be treated well with medication.

What is renal anemia?

Renal anemia is anemia caused by renal insufficiency (underfunctioning of the kidneys), which is due to a lack of erythrocytes in the blood. For what does mp stand for, please visit

The reduced number of erythrocytes, which ensure the transport of oxygen in the blood via hemoglobin (red blood pigment), leads to an undersupply of oxygen to the body and causes the symptoms typical of renal anemia, such as paleness, rapid fatigue and shortness of breath.

The likelihood of developing renal anemia increases with progressive renal insufficiency. In the case of advanced renal insufficiency (requiring dialysis, required kidney transplant), renal anemia is found in most cases.


Renal anemia is caused by chronic renal failure, which in turn can have different causes. For example, long-term diabetes, excessive consumption of painkillers and inflammatory diseases of the kidneys can cause renal insufficiency and renal anemia even at an early stage.

In healthy kidneys, over four-fifths of what is needed for erythropoietin, a hormone that stimulates erythropoiesis (erythrocyte synthesis) in the bone marrow, is produced. In the case of renal insufficiency, this hormone is not formed in sufficient quantities, so that too few erythrocytes are synthesized and renal anemia develops.

A reduced lifetime of the erythrocytes and a disturbed iron absorption by the hemoglobin can also be attributed to renal insufficiency and thus cause renal anemia.

Symptoms, Ailments & Signs

Anemia caused by renal insufficiency leads to the typical symptoms of anemia. Due to the reduced supply of oxygen, performance is reduced, patients feel tired and exhausted. Dizziness and headaches may occur.

Skin and mucous membranes are pale, they have a color similar to coffee with milk. Physical exertion causes shortness of breath (dyspnea). Initially, the breathing difficulties improve at rest, but in the advanced stage of the anemia they persist even at rest. The tongue looks red and smooth, which is what medical professionals call lacquered tongue.

In addition to the symptoms caused by anemia, other symptoms are caused by the malfunctioning of the kidneys. Blood pressure rises, the ability to concentrate decreases and states of confusion are possible. The digestive tract is also affected, resulting in diarrhea, abdominal pain, nausea, and vomiting.

Those affected often lose weight due to loss of appetite. So-called uraemic changes such as dryness, scaling and itching appear on the skin . The latter can be so strong that patients scratch their skin. It is not uncommon for these scratch marks to become infected. Damage to the kidneys can lead to cycle disorders and impotence. In some cases, sensory disturbances, calf cramps and bone pain occur. Increased heartbeat, tachycardia and cardiac arrhythmias are also possible.

Diagnosis & History

Diagnosis of renal anemia is based on a blood count, which determines the blood cell count, hemoglobin and hematocrit (total percentage of blood cells in the blood). If the value of the red blood cells is reduced with normal hemoglobin and/or the hematocrit value, a renal anemia can be assumed.

In the early stages of renal anemia, there are often no symptoms at rest, while fatigue, weakness and shortness of breath can quickly occur as a result of exercise. In the case of advanced renal anemia, these symptoms can also be observed at rest. Furthermore, renal anemia is associated with an increased cardiac output, since the organism tries to compensate for the lack of oxygen by increasing the heart’s pumping capacity.

Since renal anemia is caused by renal insufficiency, the symptoms characteristic of kidney damage (skin pallor, jaundice, gastrointestinal complaints, etc.) can be observed depending on the extent and stage of the kidney disease. In the long term, untreated renal anemia leads to reduced physical and mental performance and a reduced life expectancy.


Renal anemia often leads to complications, but these always depend on the type and severity of the underlying disease. Among other things, diabetics have the greatest risk of suffering from severe renal anemia at an early stage. However, if there is slight kidney damage, the anemia is only mild and hardly shows any symptoms. In severe cases, fatigue, a drop in performance, mental deterioration with states of confusion, shortness of breath and an increased heart rate occur.

In addition, it can lead to high blood pressure, bone pain and gastrointestinal problems. Overall, there is a high risk of serious cardiovascular disease. This applies all the more the later the treatment of renal anemia begins in patients not yet requiring dialysis. In addition, the number of hospital stays and of course the treatment costs also increase.

Overall, untreated renal anemia has a negative impact on the performance of the body and mind. In addition, there is a drastic reduction in life expectancy. The reduction in the patient’s quality of life also weighs heavily. Due to the chronic symptoms, those affected can also develop mental illnesses.

In particular, the risk of developing depression is increased. Since the hormone erythropoietin (EPO) is missing in renal anemia, it must be supplied as part of the therapy. Although the risks of this therapy are low, they can initially lead to an increase in blood pressure and a slight increase in the risk of thrombosis.

When should you go to the doctor?

This condition should always be treated by a doctor. In the worst case, if left untreated, it can lead to the death of the person concerned. As a rule, this disease can be treated relatively well with the help of medication. First and foremost, a doctor should be consulted if the patient suffers from impaired oxygen uptake. This often leads to severe tiredness and dizziness. Severe headaches that occur permanently can also indicate the disease.

In most cases, the affected person’s skin also appears very pale and shortness of breath occurs. Furthermore, severe digestive problems or a loss of appetite indicate the disease. The patient’s skin is red and itchy. If these symptoms occur over a longer period of time and make life difficult for the person concerned, a doctor must be consulted in any case. As a rule, the disease can be treated well, so that the life expectancy of the person affected is not reduced. However, complete healing is usually not achieved, so that the patient is dependent on lifelong treatment.

Treatment & Therapy

Renal anemia is treated with medication. If the renal anemia is due to an erythropoietin deficiency, which is the norm, genetically synthesized erythropoietin is injected to eliminate the existing hormone deficiency (EPO therapy or erythropoietin substitution).

Erythropoietin substitution compensates for the hormone deficiency and stimulates blood formation, which is why additional iron intake may be necessary. A sufficient amount of iron is an essential requirement for erythropoiesis.

Since the absorption of iron in the gastrointestinal tract from tablets (oral iron therapy) is only possible to a limited extent and can in many cases result in indigestion and nausea, intravenous administration (parenteral iron therapy) is recommended in renal anemia.

Erythropoietin substitution avoids blood transfusions and the associated risks (viral diseases, excessive immune system reactions, inhibition of the body’s own erythrocyte formation). For those affected who are not yet required to have dialysis, the risk of cardiovascular disease is minimized.

In the case of a kidney transplant, an improvement in renal anemia can usually be observed, since the cause of renal anemia has been eliminated with the new kidney and sufficient erythropoietin can be produced.


Since renal anemia is caused by renal insufficiency, preventive measures are aimed at avoiding kidney damage. This includes a healthy diet and the early treatment of diseases that can cause renal insufficiency (diabetes mellitus, inflammatory kidney diseases) and thus renal anemia. Regular blood value checks in chronic renal insufficiency contribute to early diagnosis and elimination of renal anemia.


Follow-up care for renal anemia depends on its cause. In any case, a regular check of the blood values ​​is necessary in order to be able to react immediately if necessary. The doctor determines the cycle. If the kidney is the trigger, this is best done by a nephrologist.

Check-ups may be necessary monthly or, if manifested, at longer intervals. In the case of renal insufficiency in particular, it can be assumed that the renal anemia will recur. It is then important to test for at least the following blood values: hemoglobin and GFR (urine production by the kidneys). Renal failure occurs as soon as the GFR falls below 15 ml/min. Hemoglobin (Hb) should not fall below 11 g/dl. Hemoglobin is the iron-containing and therefore red blood pigment that is responsible for transporting oxygen in the blood.

Iron levels can be increased with iron tablets or an injection. As soon as the hemoglobin value falls again, erythropoietin (EPO) must be administered again, the effect of which is delayed by several weeks. EPO is the hormone that stimulates the bone marrow to form blood. Since the blood pressure can rise here, it must also be checked and noted daily during aftercare. On the basis of documentation of the blood pressure values, the doctor can decide whether treatment with blood pressure-lowering agents is necessary.

You can do that yourself

Patients suffering from renal anemia can positively influence the success of the treatment by changing their diet. Since anemia is associated with a lack of iron, it is necessary to consume iron-rich foods. Especially when those affected do not tolerate the corresponding medication (such as tablets) well. Iron-rich foods include meat, whole grain products and legumes. It is advisable to ensure a sufficient supply of vitamin C (e.g. through a glass of orange juice) when consuming them, as this facilitates the absorption of iron in the body.

Depending on the stage of renal anemia, a healthy amount of exercise can also have a positive effect on the body. Relaxation exercises and movement lead to a better body feeling and can also cause concomitant diseases such as e.g. B. alleviate cardiovascular problems. The contact and exchange with like-minded people in a self-help group can also have a very positive effect on patients and their well-being.

However, going to the doctor is essential. Because the symptoms of renal anemia can only be permanently treated with medication. Those affected should have their blood values ​​checked regularly in order to be able to intervene at an early stage in the event of any deterioration.

Renal Anemia