Question
- Deficiency of erythropoietin
- Folate and Vitamin B12 deficiency
- Toxic effects of uremia on bone marrow
- Reduced utilization of dietary iron
| A. |
1, 2 and 3 |
| B. |
1, 2 and 4 |
| C. |
1, 3 and 4 |
| D. |
2, 3 and 4 |
|
Correct Answer » C Explanation |
 |
Clinical Reasoning for the Correct Answer:
– CKD causes erythropoietin deficiency (mechanism 1), as damaged kidneys produce less hormone.
– Uremic toxins inhibit bone marrow (mechanism 3), reducing erythropoiesis.
– CKD causes impaired iron utilization (mechanism 4), due to chronic inflammation and altered hepcidin metabolism, leading to functional iron deficiency.
Why Option A is Incorrect:
– Mechanism 2 (folate & B12 deficiency) is not a primary cause of anemia in CKD.
– Folate and B12 levels may be reduced due to dietary restrictions/dialysis, but true deficiency is not a main driver of CKD anemia.
Why Option B is Incorrect:
– Includes folate and B12 deficiency (mechanism 2), which is not a leading mechanism in CKD anemia.
– Omits toxic uremic effects (mechanism 3), a key contributor.
Why Option D is Incorrect:
– Lacks erythropoietin deficiency (mechanism 1), the central mechanism in CKD anemia.
– Includes folate and B12 deficiency (mechanism 2), which is not primary.
Why Option C is Correct:
– Includes erythropoietin deficiency (1), toxic uremic effects (3), and impaired iron utilization (4)—the three key mechanisms in CKD-related anemia.