Produced by renal interstitial cells in response to hypoxia
Expansion
- Produced by peritubular interstitial fibroblasts in the renal cortex, with about 10 per cent from the liver
- The stimulus is tissue hypoxia, sensed through hypoxia-inducible factor (HIF), which is degraded in normoxia by prolyl hydroxylases and stabilised in hypoxia
- Acts on erythroid progenitors in the marrow to promote proliferation and survival, with a lag of several days
Raised in anaemia, hypoxia, altitude, chronic lung disease and cyanotic heart disease, and inappropriately in renal cell carcinoma, cerebellar haemangioblastoma and hepatocellular carcinoma, all causing secondary polycythaemia.
Low relative to the degree of anaemia in chronic kidney disease, giving a normochromic normocytic anaemia. The kidney’s sensor is well placed for this role, because it sits in a tissue whose oxygen consumption is tied to filtration and therefore to blood flow.
Treatment uses recombinant erythropoiesis-stimulating agents, or the newer HIF prolyl hydroxylase inhibitors, but iron must be adequate and targets are deliberately sub-normal, since full correction increases thrombotic risk.