A client with a long-standing diagnosis of chronic kidney disease has been experiencing increasing fatigue, lethargy, and activity intolerance in recent weeks. His care team has established that his GFR remains at a low, but stable, level

Question

Which of the following assessments is most likely to inform a differential diagnosis?
A) Blood work for white cells and differential
B) Cystoscopy and ureteroscopy
C) Assessment of pancreatic exocrine and endocrine function
D) Blood work for hemoglobin, red blood cells, and hematocrit

Answer 1

Ans: D
Feedback:
Anemia is a frequent, and debilitating, consequence of CKD. The anemia may be due to chronic blood loss, hemolysis, bone marrow suppression due to retained uremic factors, and decrease in red cell production due to impaired production of erythropoietin and iron deficiency. Pancreatic function is not typically affected by CKD, and endoscopic examination is less likely to reveal a cause of fatigue. An infectious etiology is possible and would be informed by white cell assessment, but this is less likely than anemia given the client's complaints.