Which of the following statements is correct about aplastic anemia?

Rationale:

A. In end-stage renal disease (ESRD), the kidneys lose the ability to produce sufficient erythropoietin (EPO), a hormone that stimulates the bone marrow to produce red blood cells. Without adequate EPO, erythropoiesis is impaired, leading to a reduced number of circulating red blood cells and anemia. This anemia is typically normocytic and normochromic, meaning the red blood cells are of normal size and color but decreased in number.

B. ESRD does not reduce red blood cell destruction. In fact, uremic toxins in ESRD may actually shorten the lifespan of red blood cells, contributing further to anemia rather than preventing it.

C. Increased erythropoietin production is incorrect. In ESRD, erythropoietin production is diminished, not increased. The lack of EPO is the primary reason for decreased red blood cell production in these patients.

D. Elevated hemoglobin levels is incorrect. Hemoglobin levels are typically decreased in ESRD due to the reduced erythropoiesis and shortened red blood cell lifespan. Elevated hemoglobin is not a feature of anemia associated with kidney disease.

Rationale:

A. Proteinuria is the hallmark finding in nephrotic syndrome. This condition results from increased permeability of the glomerular basement membrane, allowing large amounts of protein, primarily albumin, to leak into the urine. The loss of protein in urine leads to foamy or frothy urine, which is often one of the first noticeable signs. Proteinuria also contributes to hypoalbuminemia, resulting in decreased plasma oncotic pressure, fluid shifting into interstitial spaces, and subsequent edema, commonly seen in the face, periorbital area, and lower extremities.

B. Nephrotic syndrome typically causes hyperlipidemia, not a decrease. The liver compensates for low plasma oncotic pressure by increasing lipoprotein synthesis, leading to elevated cholesterol and triglyceride levels in the blood.

C. On the contrary, nephrotic syndrome causes hypoalbuminemia due to excessive urinary loss of albumin. Low serum albumin contributes directly to the development of edema.

D. Urine output is often normal or may even be reduced in nephrotic syndrome. The condition is characterized by protein loss, not an increase in volume output. Fluid retention is more common due to hypoalbuminemia and sodium retention.