Rol de la altura en el desarrollo de eritrocitosis aislada postrasplante renal: reporte de caso

• Autores: Contreras Tovar, Angie Romina, Zevallos-Guerra, Valeria Evita, Vera-Gonzales, Gianella D., Quispe Ochoa, Grees D., Arellan-Bravo, Luis, Pando Rojas, Walter
• Formato: artículo
• Fecha de Publicación: 2025
• Institución: Colegio Médico del Perú
• Repositorio: Acta Médica Peruana
• Lenguaje: español
• OAI Identifier: oai:amp.cmp.org.pe:article/3972
• Enlace del recurso: https://amp.cmp.org.pe/index.php/AMP/article/view/3972
• Nivel de acceso: acceso abierto
• Materia: Policitemia; Insuficiencia Renal Crónica; Altitud; Trasplante de Riñón; Hipoxia; Sistema Renina-Angiotensina; Polycythemia; Chronic Renal Insufficiency; Altitude; Kidney Transplantation; Hypoxia; Renin-Angiotensin System

Post-transplant erythrocytosis (PTE) is a hematological complication occurring in approximately 10-15% of kidney transplant recipients, characterized by persistent elevation of hemoglobin and hematocrit. Residence at high altitude may constitute an additional, underexplored risk factor. We report the case of a 44-year-old male, a resident of Huancayo (3,200 meters above sea level), with stage 5 chronic kidney disease secondary to hypertensive nephropathy, on hemodialysis for 3 years, who received a living-related donor kidney transplant. Two months post-transplant, he presented with headache, distal cyanosis, and general malaise, with persistently elevated hemoglobin (19.9-22.0 g/ dL) on serial measurements. Evaluation excluded other secondary causes of erythrocytosis. Treatment with acetylsalicylic acid 100 mg/day and phlebotomy resulted in clinical and analytical improvement. In conclusion, PTE is a multifactorial entity where high altitude may act as an additional predisposing factor through mechanisms of adaptation to chronic hypobaric hypoxia. Diagnosis requires serial measurements and altitude-adjusted reference values, and management should be individualized, considering the patient's geographical context.