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 µmol/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.