26th August 2024

You review a 37-year-old man in the general medical clinic. He describes a 2-year history of fatigue

You review a 37-year-old man in the general medical clinic. He describes a 2-year history of fatigue, intermittent abdominal pains and constipation. More recently, he’s noted that he’s developed a tremor, which is disrupting his work as a welder. Until a year ago, he was fit and well with no past medical history, but since then, he has been diagnosed with hypertension, for which he is managed with ramipril and gout, for which he takes allopurinol. He has also recently started citalopram for anxiety and depression. He lives with his wife, with whom he’s been trying to conceive for over a year now with no success. He is a non-smoker and drinks approximately 5 units per week.

On examination, you note decreased sensation in his feet and lower legs bilaterally. His blood results show him to be anaemic (Hb 97) and his creatinine is raised (136) with a low eGFR (estimated glomerular filtration rate) (35).

Given the likely cause of this man’s symptoms, which treatment may be initiated?

Select the SINGLE most appropriate option from the list below. Select ONE option only.