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Certain cells in the kidney (juxtamedullary apparatus) detect blood flow to the kidney, so the body can measure the volume of blood and the amount of red blood cells in it. When the number of red blood cells in the blood gets too low, this is called anaemia. When this happens, the juxtamedullary cells detect it and can stimulate the release of a hormone called erythropoetin, which causes the bone marrow to make more red blood cells. This corrects the anaemia. Erythopoetin is also produced naturally (when not anaemic) to maintain normal numbers of red blood cells.

As the juxtamedullary cells are part of the kidney, when the kidney fails, they do too. They lose their ability to produce erythropoetin. The bone marrow stops producing normal numbers of red cells and anaemia can result.

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