Iatrogenic Iron Overload in an End Stage Renal Disease Patient

Abstract

Iron overload is a common complication in patients with chronic renal failure treated with dialysis prior to the availability of recombinant human erythropoietin therapy. Iron overload was the result of hypoproliferative erythroid marrow function coupled with the need for frequent red blood cell transfusions to manage symptomatic anemia. The repetitive use of intravenous iron with or without the use of red blood cell transfusions also contributed to iron loading and was associated with iron deposition in liver parenchymal and reticuloendothelial cells. Here we report a 56-year-old female with end-stage renal failure who underwent kidney transplant twice and found to have iatrogenic iron overload with excess intravenous iron treated conservatively.

Iron Overload in Chronic Kidney Disease: Less Ferritin, More T2*MRI

“…Furthermore, higher iron reserves in the body may shift the immunoregulatory balance negatively, compromising the immune system and complicating therapeutic management of underlying acute and chronic illnesses ( 15 ). According to recent case reports, iatrogenic iron replacement may lead to hemochromatosis (secondary iron overload) in patients with CKD, which represents an “emerging medical challenge” ( 16 , 17 ). Unfortunately, patients with CKD have few alternatives for treating hemochromatosis due to the poor creatinine clearance for most iron chelators ( 18 ).…”

The prevalence of cardiac and hepatic iron overload in patients with kidney failure: A protocol for systematic review and meta‐analysis

“… 4 , 5 While anemia represents the feature complication in patients with kidney failure, 6 the possibility of iron overload toxicity associated with continuous intravenous (IV) iron replacement is currently one of the most contentious issues in the management of anemia in patients with kidney failure. 7 …”

“…CKD diagnosis is made if the patient has a glomerular filtration rate (GFR) of <60 ml/min per 1.73 m 2 , increased urinary albumin excretion, or both, for at least 3 months, irrespective of the underlying cause and kidney failure is the 5th stage of CKD (GFR < 15 ml/min/1.73 m 2 ) 4,5 . While anemia represents the feature complication in patients with kidney failure, 6 the possibility of iron overload toxicity associated with continuous intravenous (IV) iron replacement is currently one of the most contentious issues in the management of anemia in patients with kidney failure 7 …”

“…4,5 While anemia represents the feature complication in patients with kidney failure, 6 the possibility of iron overload toxicity associated with continuous intravenous (IV) iron replacement is currently one of the most contentious issues in the management of anemia in patients with kidney failure. 7 Iron excess may have a negative impact on the heart (e.g., heart failure, arrhythmias, and sudden cardiac death), the liver (hepatocellular carcinoma), and causes other complications such as diabetes mellitus, hypogonadism, and musculoskeletal and skin-related conditions. 8,9 In addition, higher iron stores may negatively affect the immune-regulatory balance, weakening the immune system and hindering effective treatment of underlying illnesses.…”

The Superiority of T2*MRI Over Serum Ferritin in the Evaluation of Secondary Iron Overload in a Chronic Kidney Disease Patient: A Case Report

“…Moreover, the recent advance in the diagnostic test for iron overload (particularly MRI) plays a significant role in the early detection of more iron overload cases. 8,9 Because of their availability and lower cost, serum ferritin and transferrin saturation (TSAT) are frequently used to monitor iron accumulation in the body. Though, these parameters can be affected by different conditions, especially infections and variable inflammatory conditions.…”