Polycythemia and increased erythropoietin in a patient with chronic kidney disease.

Background: A 16-year-old white male with a history of obstructive uropathy presented to a pediatric outpatient clinic with a first syncope. At presentation, he had a hemoglobin level of 220 g/l, a serum erythropoietin level of 27.4 U/l and a serum creatinine level of 200.7 micromol/l (2.27 mg/dl).

Investigations: Physical examination, serum laboratory analysis, renal ultrasound, MRI, and 99mTc-MAG3 scintigraphy of the kidneys.

Diagnosis: Chronic renal insufficiency caused by obstructive hydronephrosis and accompanied by increased erythropoietin levels of renal origin and polycythemia.

Management: Serial phlebotomies and laparoscopic removal of the right hydronephrotic kidney.