I have a 35 year old patient who recently received his second kidney transplant. He received his first transplant in his 20s in Albania after going into renal failure due to SSG (that’s Some Sort of Glomerulonephritis, a typical diagnosis for a patient who emigrates to the US with a failing transplant and little medical history).
Soon after his transplant his hemoglobin began to rise. We initiated phlebotomy when his hemoglobin rose above 19.
His hemoglobin fell to 17.2 but then increasd up to 18.5.
I started 5 mg of enalepril and it fell to 16.9.
I increased the enalepril to 10 mg and it fell to 16.2 and continued to fall until it is now around 14.
i'm sure this is a dumb question but… I understand the erythrocytosis occurring due to sudden increase in epo from the new kidney but… why did the ace inhibitor make a difference?
Sorry Snipergirl. This is kind of just half a post.
ACEi and ARB cause anemia. In RENAAL, patients randomized to losartan had Hgb 0.6 g lower than controls after one year.
The mechanism is at least in part related to blockade of erythropoietic effects of angiotensin II on red cell production and improved renal blood flow secondary to renal efferent vasodilation, which improves oxygenation decreases the stimuli for erythropoietin.