抄録
The anemia associated with chronic renal failure does not respond to usual therapeutic measures and is a very serious problem.
We postulated that decreased production of erythropoietin (ESF), presence of erythropoiesis inhibiting factor (EIF), decreased responsiveness of the bone marrow to ESF, increased red cell destruction and impaired immunological reactivity take part in the pathophysiology of this type of anemia.
Numerous reports have suggested that androgen may enhance the endogenous production of ESF. On the other hand, in some patients well-maintained on a regimen of long-term hemodialysis, ESF activity in plasma was detectable.
The present study was undertaken to investigate the mechanism underlyning the influence of large dose of androgen on erythropoiesis in patients undergoing chronic hemodialysis programs.
The clinical material comprises 14 male and 3 female patients who have been maintained on long-term hemodialysis. Intramuscular injections of androgen (Methenolone enanthate) 400 mg weekly were given to them, usually just after hemodialysis, for 7 to 15 weeks. Our patient's general condition was improved. And androgen produced a significant rise in hemoglobin values, hematocrit and especially in reticulocyte counts. There was no significant difference in the serum iron level, but the unsaturated ironbinding capacity returned to normal. In ferrokinetic studies, most of patients showed marrow improvement to respond to androgen. We have observed the increase in ESF activity on response to androgen therapy in six patients.
Kidney on long-term hemodialysis showed fat deposit and plasma exsudate in the glomeruli in addition to obsolescence of the nephron. It is suggested that “this kidney” without functioning renal tissue cannot excrete the sufficient amount of ESF.
On the basis of these observations, it appears to be question that an extrarenal ESF site(s) may respond to the stimulation with exogenous androgenic hormone.
