A patient with acute kidney injury has a hemoglobin level of 9.0 mg/dL. Which of the following best explains why this laboratory value is decreased in the patient?
1. undiagnosed gastrointestinal bleeding
2. fluid volume overload causing hemodilution
3. decreased erythropoietin production by the kidneys
4. reduced capillary permeability in the lungs
3
Rationale: The kidneys produce erythropoietin in response to decreased oxygen delivery to the kidneys. Erythropoietin is necessary for red blood cell production and also plays a role in maintaining healthy endothelium, promotes angiogenesis and anti-apoptosis. When kidney function deteriorates, red blood cell production is compromised and the life span of the existing red blood cells may decrease. The patient may or may not have undiagnosed gastrointestinal bleeding. The patient's fluid volume is not causing hemodilution. Reduced capillary permeability in the lungs might lead to hypoxemia.
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