Transferrin loss into the urine with hypochromic, microcytic anemia.
Anemia developing during the course of chronic renal disease is a frequent complication often necessitating periodic transfusion therapy. A number of etiologic factors have been implicated, including decreased production of erythropoietin; decreased erythrocyte life span secondary to uremia and splenomegaly; increased bleeding tendency due to platelet dysfunction; and acquired lack of folic acid and iron. This paper concerns the problem of acquired hypochromic, microcytic anemia secondary to heavy urinary loss of iron and transferrin in a child with the nephrotic syndrome. The patient had microcytic, hypochromic anemia with serum iron, 12 mug. per dl. and a serum iron-binding capacity of 12 mug. per dl. There was no evidence of major bleeding resulting in a chronic hemorrhagic anemia. Urinary iron was 64 mug. per dl., with a urinary iron-binding capacity of 366 mug. per dl. Renal biopsy showed mesangio-proliferative glomerulonephritis. Evaluation of any patient with the nephrotic syndrome should include careful analysis of the various serum and urinary proteins and determination of serum and urinary iron and iron-binding capacity. This information would offer a more precise evaluation of the underlying cause of anemia in the nephrotic patient who may develop urinary loss of iron and transferrin and subsequent hypochromic, microcytic anemia.
D000747:Anemia, Hypochromic / Q000209:etiology* / Q000473:pathology / Q000652:urine; D001798:Blood Proteins / Q000032:analysis; D002648:Child; D006801:Humans; D007501:Iron / Q000097:blood / Q000652:urine; D007668:Kidney / Q000473:pathology; D009404:Nephrotic Syndrome / Q000150:complications* / Q000473:pathology / Q000652:urine; D014168:Transferrin / Q000652:urine*
D001798:Blood Proteins; D014168:Transferrin; D007501:Iron