Lethargy

Causes of anaemia in CKD
1) Decreased Erythropoietin
2) Anaemia of Chronic Disease
3) Uraemic Gastritis
4) Osteitis Fibrosa Cystica (bone marrow failure)
5) IDA due to malnutrition
6) uraemia causing bone marrow suppresion

Causes of anaemia in RA
1) anaemia of chronic disease
2) IDA sec to GI bleeding due to NSAIDs
3) Bone marrow suppression due to methotrexate(can cause folate deficiency too)
4) association with felty syndrome or pernicious anaemia
5) autoimmune haemolytic anaemia



Clinical Case for fun:
A gentleman with underlying ESRD on long term haemodialysis for the past 5 years presents to you with pain with numbness in his left hand, and on examination, he has got left sided median nerve palsy with positive tinel's sign.
Tissue biopsy of the affected site is taken. Amyloid deposits are positive for Congo red staining, showing green birefringence of the amyloid fibrils under polarized light.

Diagnosis: Carpal Tunnel Syndrome secondary to Dialysis Related Amyloidosis(decreased clearance of Beta2-microglobulin)

**long standing RA can cause amyloidosis too (AA- serum amyloid A protein)