Patient with anemia in CKD. What is the etiology?

Kidney Quiz – Anemia, CKD, Blood in Stool

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Background:

73-year-old man with chronic kidney disease stage 4 is noted to have fatigue and blood in the stool. Work up reveals a hemoglobin of 8, iron deficiency anemia, negative colonoscopy, and the gastric lesion shown above.

Please answer the following questions:

What is the diagnosis?


Telangiectasia is a term only used in hereditary hemorrhagic telangiectasia
True or False

Angiodysplasias are most commonly reported in the small intestine.
True or False

Associations of gastrointestinal angiodysplasia with aortic stenosis have not been reported.
True or False

Angiodysplasias are composed of thick-walled vessels.
True or False

The prevalence of angiodysplasia decreases with age.
True or False

Gastric Angiodysplasia

Overview

Gastric angiodysplasia from advanced chronic kidney disease (CKD) is the most likely diagnosis. Gastric angiodysplasia is characterized by ectatic, dilated, thin-walled vessels commonly found in the gastrointestinal tract. The colon is the most frequent location to see angiodysplasia; however, angiodysplasia leading to blood loss anemia can also be seen in the gastric area.

Terminology

Angiodysplasias are also known as arteriovenous malformations, angiectasia, and vascular ectasia.

Prevalence and Associations

  • Prevalence of angiodysplasia increases with age.
  • Most cases have no clear cause.
  • Associations have been reported with not only advanced chronic kidney disease but also von Willebrand disease and aortic stenosis.

Inspiration: Angiodysplasia, National Library of Medicine

Related:

Severe Anemia In CKD, Hb 7.2 – Treatment – Nephrology Quiz by Michael Aaronson MD