side effect of ACE-I/ARBs

 Q: Which side effect of Angiotensin-Converting Enzyme (ACE) inhibitors can be used as a treatment in post-transplant patients?

Answer: Anemia

ACE inhibitors as well as Angiotensin II receptor blockers (ARBs) suppress erythropoietin. This suppression is enhanced in patients with renal insufficiency. This occurs due to accumulation of the compound N-acetyl-seryl-aspartyl-lysyl-proline. This compound causes inhibition of stem cell multiplication. This side effect of ACE-I and ARBs is used in two forms of anemia

•  posttransplant erythrocytosis, and 
• high altitude increase in red cells 

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References:

1. Yildiz A, Cine N, Akkaya V, et al. Comparison of the effects of enalapril and losartan on posttransplantation erythrocytosis in renal transplant recipients: prospective randomized study. Transplantation 2001; 72:542. 

2. Plata R, Cornejo A, Arratia C, et al. Angiotensin-converting-enzyme inhibition therapy in altitude polycythaemia: a prospective randomised trial. Lancet 2002; 359:663.