Episode 1 : Bleeding in Chronic Kidney Disease

Chronic kidney disease can cause bleeding due to platelet dysfunction caused by increased uric acid. This uric acid buildup leads to the activation of nitric acid, which inhibits platelet aggregation and causes bleeding. Anemia is also common in chronic kidney disease due to the lack of erythropoietin production. Bleeding can be treated with desmopressin to increase platelet aggregation. Cryoprecipitate or fresh frozen plasma are not viable treatment options. In today's episode, we're going to start with Episode 1, and Episode 1 is about the causes of bleeding in chronic kidney disease. Chronic kidney disease is actually a kind of a renal failure that has occurred for a period of time. And we know quite right that the kidney is the site of production of erythropoietin and also with thrombopoietin. But in renal failure, the bleeding that is associated with renal failure is as a result of platelet dysfunction. And the cause of this platelet dysfunction is as a result of the increase in the uric acid that is being built up as a result of the inability of the kidney to filter and reabsorb uric acid. So uric acid buildup normally leads to the increased activation of nitric acid, and this increased activation of nitric acid tends to inhibit platelet aggregation. And the inhibition of platelet aggregation normally will cause bleeding effects to actually occur. And then also, individuals with chronic kidney disease, because the kidney is also the site of erythropoietin, we can also see anemia. If we take a look at the MCV value of this anemia that is caused by kidney disease, it's going to be in the normal acidic range, or it's going to be between 80 and 100. But one thing that is also clear is that hemoglobin is going to be low because of the lack of production of erythropoietin. Erythropoietin, we said, is a cytokine or a hormone that stimulates the bone marrow and microenvironments to produce erythrocytes, or stimulate the stem cells to produce erythrocytes. So looking at these two factors of increasing in uric acid, which triggers nitric oxide production, and increased nitric oxide production causes an inhibition in platelet aggregation, which then leads to bleeding that we talked about, and also leads to decreased incidences of platelet as well. So bleeding in chronic kidney disease can be treated by the use of desmopressin, which normally will increase the bone-reliever factor, which can then cause increasing platelet aggregation and also cause facial constriction to occur. So in doing so, you can actually mitigate the effects of bleeding in that particular sense as well. And that is it for our today's episode on the cause of bleeding in chronic kidney disease. I know there are other things that you might think about to treat it, such as cryoprecipitate or fresh frozen plasma. At the long run, these are not a viable option for this particular patient. So with that, I'm going to stop this recording, and if you have any questions, please feel free to reach out to me, Dr. Asamoda, and you can also reach out to my online web class on hematology. Thanks.