What causes excessively high ferritin levels in patients with uremia?

Generally, elevated ferritin levels in patients with uremia may be caused by abnormalities in glomerular filtration membrane barrier function, chronic aplastic anemia, or myelodysplastic syndromes. The specific analysis is as follows:

1. Glomerular filtration membrane barrier dysfunction: The glomerular filtration membrane is a key structure in the kidneys responsible for filtering blood and removing waste products. If the barrier function of this membrane is impaired—due to injury or disease—the glomeruli may fail to effectively filter waste and solutes from the blood, including ferritin. This can lead to increased excretion of ferritin in urine and consequently elevated serum ferritin levels in uremic patients.

2. Chronic aplastic anemia: This condition involves impaired function of hematopoietic stem cells, leading to reduced red blood cell counts. To compensate for this deficiency, patients often receive blood transfusions. Transfused blood contains significant amounts of iron, and repeated transfusions can increase ferritin levels in the bloodstream. When such patients eventually develop uremia due to progressive decline in kidney function, reduced renal filtration capacity further impairs ferritin clearance, resulting in its accumulation.

3. Myelodysplastic syndromes (MDS): MDS refers to a group of disorders characterized by abnormal proliferation of hematopoietic cells in the bone marrow. Due to ineffective blood cell production, patients often require frequent blood transfusions, similar to those with chronic aplastic anemia. The iron introduced through these transfusions tends to accumulate in uremic patients, contributing to elevated ferritin levels.

If a uremic patient presents with high ferritin levels, it is recommended to promptly identify the underlying cause and initiate appropriate symptomatic treatment to prevent disease progression.