Bilateral Native Nephrectomy as a Successful Treatment for Persistent Polycythemia in a Pediatric Kidney Transplant Recipient: Case Report

Introduction Polycythemia, characterized by elevated red blood cell counts, can lead to significant complications, especially in pediatric kidney transplant patients. In rare cases, persistent polycythemia is caused by excessive erythropoietin production from native kidneys post‐transplant. We report a unique case in which bilateral native nephrectomy was a successful treatment for persistent polycythemia. Methods We present the case of a 23‐year‐old male with end‐stage kidney disease due to an embolic event from an umbilical artery catheter resulting in bilateral kidney cystic dysplasia. The patient developed polycythemia at 22 months, initially treated with intermittent phlebotomy, which later transitioned to red cell depletion. Despite receiving a living donor kidney transplant at age 15, his hematocrit remained elevated due to continued erythropoietin production from his native kidneys. At age 17, he underwent robotic bilateral native nephrectomies. Results/Important Clinical Findings Following the nephrectomies, the patient's hematocrit was normalized within 2 months. The surgery was complication‐free, and the patient no longer required red cell depletion. Five years post‐surgery, his hemoglobin and hematocrit remain stable. Conclusions This case demonstrates that persistent polycythemia in pediatric kidney transplant recipients can be successfully treated with bilateral nephrectomies when caused by native kidney erythropoietin production. Surgical removal of native kidneys is a viable solution for refractory cases of post‐transplant polycythemia, preventing complications like thromboembolic events and preserving long‐term health. A multidisciplinary approach, including urology and nephrology, is essential in managing such complex cases.