[Erythrocytosis, renal artery stenosis and arterial hypertension in a kidney transplant recipient].

A 53-year-old man with end-stage renal disease received a cadaver kidney after 15 months of peritoneal dialysis. Within one year of transplantation he developed hypertension and erythrocytosis. Percutaneous transluminal angioplasty was performed but 13 months later magnetic resonance angiography showed an anastomotic stenosis of the renal artery in the graft. In the meantime, he was submitted to venesections while the hypertension proved resistant to a multiple-drug combination. After two years, color Doppler sonography performed at our unit showed a noncritical stenosis, so we decided to start the patient on ACE inhibitors followed by angiotensin receptor blockers. A reduction of hematocrit to < 50% and partial control of blood pressure with stable renal function was obtained. Later we added minoxidil at low dosage, which resulted in excellent blood pressure control. The diagnosis of hemodynamically significant stenosis is not always easy to make; in this case a correct diagnosis was helpful for the treatment of erythrocytosis.