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Erythrocytosis post kidney transplant is known to have a prevalence of 2.5% to 22.2% among kidney recipients. The pathogenesis of this condition is multifactorial but not entirely clear. Over production of erythropoietin by retained native kidneys, renin angiotensin system activation among other factors have been implicated. Treatment modalities available include repeated phlebotomies, use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers and native kidney nephrectomy. We report the case of a 43 year old man who had kidney transplantation for end-stage renal disease secondary to chronic glomerulonephritis and developed erythrocytosis 26 months post-transplant. He became symptomatic at 32 months post-transplant and had elevated serum erythropoietin level. He was treated with repeated phlebotomy and ACE inhibitors with good results. Current concepts in the pathogenesis and treatment of post renal transplant erythrocytosis were reviewed also.