CKD stage 4 — ESENeph MCQ
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Correct answer: D — Hypochromic red cells above 6%
The best answer is “Hypochromic red cells above 6%”. NICE prefers hypochromic red cells when timely processing is possible. Reticulocyte haemoglobin below 29 pg is the next option; if unavailable, combined TSAT below 20% and ferritin below 100 micrograms/L is used. “Serum ferritin as a standalone test” is less appropriate because ferritin alone can be misleading in inflammation and is not recommended as the sole assessment “Serum erythropoietin concentration” is less appropriate because NICE advises against routine erythropoietin measurement for diagnosis or management “Bone-marrow iron staining before non-invasive testing” is less appropriate because this invasive procedure is not the routine first assessment “Mean corpuscular volume as the definitive test” is less appropriate because MCV lacks sensitivity and specificity for iron availability in CKD
Reference: NICE NG203: CKD assessment and management: https://www.nice.org.uk/guidance/ng203/chapter/Recommendations