# Management of Pediatric Post-renal Transplant Erythrocytosis With Enalapril: A Case Report

## TL;DR

A child with high red blood cell count after a kidney transplant was successfully managed with enalapril and losartan, maintaining healthy blood levels and kidney function for five years.

## Contribution

This case report demonstrates the successful use of renin-angiotensin system blockade for managing post-transplant erythrocytosis in a pediatric patient.

## Key findings

- Enalapril normalized hemoglobin levels in a pediatric patient with post-transplant erythrocytosis.
- Losartan effectively controlled hypertension and proteinuria while maintaining hemoglobin within target range.
- Long-term management of post-transplant erythrocytosis was achieved without compromising graft function.

## Abstract

Post-transplant erythrocytosis (PTE) is a well-documented complication in adult renal transplant recipients but is less commonly reported in pediatric cases. We present an eight-year-old female patient with end-stage renal disease (ESRD) secondary to immune complex-mediated glomerulonephritis, who developed erythrocytosis 10 months after a deceased donor kidney transplant. Despite normal erythropoietin levels and mild obstructive sleep apnea, her hemoglobin (17 g/dL) and hematocrit (52%) remained elevated. She was initially treated with enalapril (2.5 mg daily), leading to hemoglobin normalization, later switched to losartan (titrated to 50 mg daily) for hypertension and proteinuria. Over five years, her hemoglobin has remained within the target range (11.5-14.5 g/dL), with controlled blood pressure and proteinuria. This case highlights the successful long-term management of pediatric PTE with renin-angiotensin system blockade while preserving graft function.