PTE

 Case: 59 years old male with a history of kidney transplant due to polycystic kidney disease is admitted to ICU with massive pulmonary embolism.  Initial workup showed hematocrit of 54 percent. What could be the probable diagnosis?

Answer: post-transplant erythrocytosis (PTE) 

There are many risk factors that lead to post-transplant erythrocytosis (PTE). These include 

• male gender 
• a rejection-free course 
• preserved GFR 
• hypertension
• diuretic use 
• longer duration of dialysis 
• smoking 
• diabetes history 
• polycystic kidney disease (PKD) 
•  glomerulonephritis as a cause of kidney failure  
• retained native kidneys 

First suspected four decades ago, retained native kidneys usually become the source of increased erythropoietin. The associated phenomenon is called "tertiary hypererythropoietinemia," where biological feedbacks that suppress erythropoietin become dysfunctional. 

Treatment includes ACE inhibitors/ARBs and phlebotomy.

#transplantation

#nephrology

References:

1. Vlahakos DV, Marathias KP, Agroyannis B, Madias NE. Posttransplant erythrocytosis. Kidney Int 2003; 63:1187.

2. Dagher FJ, Ramos E, Erslev AJ, et al. Are the native kidneys responsible for erythrocytosis in renal allorecipients? Transplantation 1979; 28:496.

3. Einollahi B, Lessan-Pezeshki M, Nafar M, et al. Erythrocytosis after renal transplantation: review of 101 cases. Transplant Proc 2005; 37:3101.

4. Aeberhard JM, Schneider PA, Vallotton MB, et al. Multiple site estimates of erythropoietin and renin in polycythemic kidney transplant patients. Transplantation 1990; 50:613.