Nephrology: anaemia of chronic kidney disease: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Nephrology: anaemia of chronic kidney disease

Sample item

A patient with chronic kidney disease and a haemoglobin of 8 g/dL does not respond to erythropoiesis-stimulating agent therapy. What is the most common cause of poor response?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Iron deficiency

Anaemia of CKD results from reduced erythropoietin production, and ESAs are effective only if iron stores are adequate. Absolute or functional iron deficiency is the commonest cause of hyporesponsiveness, so iron is replaced, often intravenously. Other causes include inflammation, infection and aluminium toxicity.

Option by option

  • A. Iron deficiency (correct)

    Correct. Iron deficiency is the leading cause of ESA resistance.

  • B. Hypothyroidism

    Hypothyroidism is a less common contributor.

  • C. Antibodies to erythropoietin

    Anti-erythropoietin antibodies causing pure red cell aplasia are rare.

  • D. Hyperparathyroidism alone

    Hyperparathyroidism may contribute but is not the commonest cause.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Iron deficiency. Anaemia of CKD results from reduced erythropoietin production, and ESAs are effective only if iron stores are adequate.

Why is "Hypothyroidism" not the answer?

Hypothyroidism is a less common contributor.

Why is "Antibodies to erythropoietin" not the answer?

Anti-erythropoietin antibodies causing pure red cell aplasia are rare.

Why is "Hyperparathyroidism alone" not the answer?

Hyperparathyroidism may contribute but is not the commonest cause.

What concept does this question test?

It tests Nephrology: anaemia of chronic kidney disease in General Medicine. Absolute or functional iron deficiency is the commonest cause of hyporesponsiveness, so iron is replaced, often intravenously. Other causes include inflammation, infection and aluminium toxicity.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Nephrology: anaemia of chronic kidney disease?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.