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1
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Taniguchi T, Yamamoto K, Tomita M, Iehara N. Renal tamponade in a patient with hydronephrosis-related Page kidney. CEN Case Rep 2023; 12:378-383. [PMID: 36856751 PMCID: PMC10620360 DOI: 10.1007/s13730-023-00779-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 02/14/2023] [Indexed: 03/02/2023] Open
Abstract
A 48-year-old woman presented with hyperreninemic hypertension and renal dysfunction and was diagnosed with hydronephrosis-related Page kidney. The pathophysiology was "renal tamponade", in which the kidney was compressed by the renal pelvis and Gerota's fascia, resulting in intrarenal microvascular ischemia. Ureteral stent placement promptly improved the hyperreninemic hypertension and renal dysfunction, and additional perirenal fluid drainage gradually improved these conditions. These observations indicated the following three points. First, renal compression-induced renin-angiotensin-aldosterone system upregulation plays an important role in the pathogenesis of Page kidney. Second, physicians should consider perirenal fluid drainage as a therapeutic option in addition to ureteral stenting in patients with hydronephrosis-related Page kidney. Third, bilateral perirenal subcapsular hematomas in this case could be caused by hydronephrosis. Hydronephrosis-induced intrarenal pressure elevation possibly caused chronic perirenal subcapsular hemorrhage at the vulnerable sites of the renal cortex and peeling of the renal capsule from the cortex, resulting in the bilateral massive subcapsular hematomas and Page kidney.
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Affiliation(s)
- Tomoki Taniguchi
- Department of Nephrology, Kyoto City Hospital, 1-2 Mibu Higashitakadacho, Nakagyo-Ku, Kyoto-Shi, Kyoto-Fu, Kyoto, 604-8845, Japan.
| | - Kojiro Yamamoto
- Department of Nephrology, Kyoto City Hospital, 1-2 Mibu Higashitakadacho, Nakagyo-Ku, Kyoto-Shi, Kyoto-Fu, Kyoto, 604-8845, Japan
| | - Mayumi Tomita
- Department of Nephrology, Kyoto City Hospital, 1-2 Mibu Higashitakadacho, Nakagyo-Ku, Kyoto-Shi, Kyoto-Fu, Kyoto, 604-8845, Japan
| | - Noriyuki Iehara
- Department of Nephrology, Kyoto City Hospital, 1-2 Mibu Higashitakadacho, Nakagyo-Ku, Kyoto-Shi, Kyoto-Fu, Kyoto, 604-8845, Japan
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2
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Acute Renal Failure in Kidney Transplantation Due to Subcapsular Hematoma After a Renal Allograft Biopsy: Report of Two Cases and Literature Review. Transplant Proc 2020; 52:530-533. [PMID: 32033833 DOI: 10.1016/j.transproceed.2019.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 09/03/2019] [Indexed: 11/23/2022]
Abstract
The compression of the renal parenchyma due to a subcapsular hematoma, also known as the "Page kidney," is a potentially serious but treatable complication of renal biopsy. Hypertension is very common and, in some cases, renal failure may be present. In kidney transplantation, it is a not well-described entity. Rapid intervention is essential to avoid irreversible damage of the graft and preserve its function. We report 2 cases of acute renal failure due to Page kidney in patients with renal transplant after a percutaneous biopsy with successful recovery after surgical treatment. In addition, we conducted a literature review in order to describe the clinical characteristics of this infrequent complication in patients with a history of renal transplant.
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3
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Hori S, Tomizawa M, Maesaka F, Owari T, Morizawa Y, Nakai Y, Miyake M, Yoneda T, Tanaka N, Yoshida K, Fujimoto K. Unexpected presentation of allograft dysfunction triggered by page kidney phenomenon immediately after kidney transplantation: a case report. BMC Nephrol 2018. [PMID: 29534686 PMCID: PMC5851246 DOI: 10.1186/s12882-018-0860-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Page kidney phenomenon is caused by strong renal parenchymal compression and leads to renal hypoperfusion and microvascular ischemia, resulting in renal dysfunction and hypertension. Although the development of Page kidney phenomenon in allograft is rare, most of its cases are induced by allograft biopsy or trauma. We observed a case of Page kidney phenomenon that was induced by unusual causes immediately after kidney transplantation. Case presentation A 66-year-old man, whose wife donated a kidney, underwent ABO-compatible living kidney transplantation. The allograft had three renal arteries that were trimmed and formed into one piece on the back table, and subsequently, it was anastomosed to the internal iliac artery. Intraoperative Doppler ultrasonography (US) revealed adequate blood flow of each renal artery. Urine output was also observed as soon as allograft blood flow was reperfused. After the surgery, the urine output decreased, and serum creatinine level increased to 6.0 mg/dL. Doppler US did not show evidence of acute rejection, ureteral obstruction, or anastomotic stenosis of the renal arteries. On postoperative day 7, surgical exploration was performed and revealed that the blood flow of each renal artery was adequate but subcapsular hematoma was detected at the upper pole of the allograft. Capsulotomy and hematoma evacuation were performed. Subsequently, urine output increased and serum creatinine level decreased up to 1.7 mg/dL. Allograft sample was obtained 1 h after the transplantation from the lower pole of the allograft. Although the cause of subcapsular bleeding was unclear in this case, a small cyst of the allograft, which might have ruptured during donor nephrectomy, was located in the middle of the hematoma, and oozing around the cyst was observed. Conclusions Our case indicated that the small ruptured cyst of the allograft could be the cause of subcapsular hematoma and Page kidney phenomenon. Subcapsular hematoma caused by oozing over time could be difficult to diagnose using Doppler US, and thus, other imaging modalities, such as computed tomography, should be considered. Knowledge of the Page kidney phenomenon in the allograft can lead to early diagnosis and intervention, resulting in better outcomes for recipients with allograft dysfunction.
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Affiliation(s)
- Shunta Hori
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Mitsuru Tomizawa
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Fumisato Maesaka
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Takuya Owari
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yosuke Morizawa
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Tatsuo Yoneda
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Katsunori Yoshida
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
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4
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Takahashi K, Prashar R, Putchakayala KG, Kane WJ, Denny JE, Kim DY, Malinzak LE. Allograft loss from acute Page kidney secondary to trauma after kidney transplantation. World J Transplant 2017; 7:88-93. [PMID: 28280700 PMCID: PMC5324033 DOI: 10.5500/wjt.v7.i1.88] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 12/19/2016] [Accepted: 01/11/2017] [Indexed: 02/05/2023] Open
Abstract
We report a rare case of allograft loss from acute Page kidney secondary to trauma that occurred 12 years after kidney transplantation. A 67-year-old Caucasian male with a past surgical history of kidney transplant presented to the emergency department at a local hospital with left lower abdominal tenderness. He recalled that his cat, which weighs 15 lbs, jumped on his abdomen 7 d prior. On physical examination, a small tender mass was noticed at the incisional site of the kidney transplant. He was producing a normal amount of urine without hematuria. His serum creatinine level was slightly elevated from his baseline. Computer tomography revealed a large subscapular hematoma around the transplant kidney. The patient was observed to have renal trauma grade II at the hospital over a period of three days, and he was finally transferred to a transplant center after his urine output significantly decreased. Doppler ultrasound demonstrated an extensive peri-allograft hypoechoic area and abnormal waveforms with absent arterial diastolic flow and a patent renal vein. Despite surgical decompression, the allograft failed to respond appropriately due to the delay in surgical intervention. This is the third reported case of allograft loss from acute Page kidney following kidney transplantation. This case reinforces that kidney care differs if the kidney is solitary or a transplant. Early recognition and aggressive treatments are mandatory, especially in a case with Doppler signs that are suggestive of compression.
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5
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Recurrence of Acute Page Kidney in a Renal Transplant Allograft. Case Rep Med 2016; 2016:3898307. [PMID: 27725836 PMCID: PMC5048039 DOI: 10.1155/2016/3898307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/16/2016] [Accepted: 08/17/2016] [Indexed: 11/26/2022] Open
Abstract
Acute Page Kidney (APK) phenomenon is a rare cause of secondary hypertension, mediated by activation of renin-angiotensin-aldosterone system (RAAS). Timely intervention is of great importance to prevent any end organ damage from hypertension. We present a unique case of three episodes of APK in the same renal transplant allograft.
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6
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Page kidney of renal allograft following blunt trauma. Clin Nephrol Case Stud 2015; 3:5-7. [PMID: 29043126 PMCID: PMC5438011 DOI: 10.5414/cncs108447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 02/25/2015] [Indexed: 11/18/2022] Open
Abstract
We report a case of the Page kidney phenomenon which occurred in a patient with a renal allograft following blunt trauma. The injury occurred following an accidental trip resulting in a trivial fall. The patient presented with acute graft dysfunction with no localizing symptoms or signs. His renal function deteriorated further and he also became hypertensive. Serial ultrasounds showed an increase in the size of perinephric hematoma and evidence of renal compression. Prompt surgical evacuation of the hematoma was performed and renal function returned to baseline. Serial ultrasound examinations and timely surgical intervention can prevent graft loss in this unusual situation.
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7
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Thiyagarajan UM, Bagul A, Mohamed I, Nicholson ML. Post-biopsy renal allograft compartment syndrome: Addressing the problem, illustrated with a case report. Int J Surg Case Rep 2011; 2:188-90. [PMID: 22096723 DOI: 10.1016/j.ijscr.2011.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2011] [Accepted: 06/13/2011] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Renal allograft compartment syndrome (RACS) has recently been coined to describe early allograft dysfunction secondary to raised pressure in the retroperitoneal space. This may be caused by direct compression of the renal vessels or by a diffuse renal parenchymal compression. Herein, we report a renal allograft compartment syndrome secondary to a needle core transplant biopsy and discuss the management strategies in line with an updated literature review. PRESENTATION OF CASE A retrospective case-note review was carried out where a 45-year-old male had a transplant renal biopsy at 4-weeks after transplant for raising creatinine. Following biopsy patient developed abdominal discomfort and had haematuria. DISCUSSION Doppler ultrasound scanning of graft demonstrated good perfusion but a small haematoma (2 × 2 × 2 cm) in the upper pole of the kidney at the site of the biopsy. Patient was thereafter assessed conservatively with serial ultrasound monitoring. After 24 h, significant deterioration of graft function was observed. The third scan, demonstrated reversed flow in diastole in the upper pole of the kidney with a resistive index of 1.0 in the main renal vessel. With the above findings the kidney transplant was explored immediately and the transplant released from a 300 ml of liquefied haematoma, which was under considerable pressure. In the next 24-h, the patient showed an immediate return of graft function. CONCLUSION We recommend sequential ultrasound Doppler scanning as an invaluable tool to help identify early RACS. The surgical exploration and adequate heamostasis with surgical glue should be sought out in all RACS.
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Affiliation(s)
- U Mathuram Thiyagarajan
- Department of Infection, Immunity & Inflammation, Transplant Group, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, United Kingdom
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8
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Heffernan E, Zwirewich C, Harris A, Nguan C. Page kidney after renal allograft biopsy: sonographic findings. JOURNAL OF CLINICAL ULTRASOUND : JCU 2009; 37:226-229. [PMID: 18386812 DOI: 10.1002/jcu.20465] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The development of renal failure and hypertension due to extrinsic renal compression by hematoma in the subcapsular space is well-described and most commonly seen after blunt trauma. It may also occur as a complication of percutaneous renal biopsy, both in native kidneys and renal allografts, and is a rare cause of reversible allograft failure. We describe a case of Page kidney in renal transplantation after percutaneous biopsy causing allograft dysfunction. Early recognition with sonography is important if irreversible damage to the allograft is to be prevented.
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MESH Headings
- Biopsy, Needle/adverse effects
- Biopsy, Needle/methods
- Decompression, Surgical/methods
- Follow-Up Studies
- Graft Survival
- Hematoma/diagnostic imaging
- Hematoma/etiology
- Hematoma/surgery
- Humans
- Kidney Diseases/diagnostic imaging
- Kidney Diseases/etiology
- Kidney Diseases/surgery
- Kidney Failure, Chronic/surgery
- Kidney Transplantation/adverse effects
- Kidney Transplantation/methods
- Laparotomy/methods
- Male
- Middle Aged
- Monitoring, Physiologic/methods
- Risk Assessment
- Transplantation, Homologous/adverse effects
- Transplantation, Homologous/pathology
- Treatment Outcome
- Ultrasonography, Doppler, Color
- Ultrasonography, Doppler, Duplex
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Affiliation(s)
- Eric Heffernan
- Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
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9
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Chung J, Caumartin Y, Warren J, Luke PPW. Acute Page kidney following renal allograft biopsy: a complication requiring early recognition and treatment. Am J Transplant 2008; 8:1323-8. [PMID: 18444936 DOI: 10.1111/j.1600-6143.2008.02215.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The acute Page kidney phenomenon occurs as a consequence of external compression of the renal parenchyma leading to renal ischemia and hypertension. Between January 2000 and September 2007, 550 kidney transplants and 518 ultrasound-guided kidney biopsies were performed. During that time, four recipients developed acute oligo-anuria following ultrasound-guided allograft biopsy. Emergent doppler-ultrasounds were performed demonstrating absence of diastolic flow as well as a sub-capsular hematoma of the kidney. Prompt surgical exploration with allograft capsulotomy was performed in all cases. Immediately after capsulotomy, intraoperative Doppler study demonstrated robust return of diastolic flow. Three patients maintained good graft function, and one kidney was lost due to acute antibody-mediated rejection. We conclude that postbiopsy anuria associated with a subcapsular hematoma and acute absence of diastolic flow on doppler ultrasound should be considered pathognomonic of APK. All renal transplant specialists should be able to recognize this complication, because immediate surgical decompression can salvage the allograft.
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Affiliation(s)
- J Chung
- Department of Surgery, Division of Urology, University of Western Ontario, Canada
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10
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Abstract
Renal trauma is rare, and significant complications from renal trauma are generally rarer still occurring in less than 5% in modern series. Close follow-up of injured patients and scrupulous use of imaging, including computed tomography scan, arteriogram, or retro-grade pyelogram when appropriate, increase detection rates and establish the diagnosis in most patients. Treatment varies by etiology and may range from watchful waiting to percutaneous drainage to, in rare cases, nephrectomy.
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Affiliation(s)
- Hosam S Al-Qudah
- Department of Urology, Wayne State University School of Medicine, Detroit, MI 48201, USA
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11
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Díaz Izquierdo L, Manrique Legaz A. [Isotopic studies in pediatric nephrourology]. REVISTA ESPANOLA DE MEDICINA NUCLEAR 2004; 23:207-27; quiz 228-30. [PMID: 15153368 DOI: 10.1016/s0212-6982(04)72286-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- L Díaz Izquierdo
- Servicio de Medicina Nuclear, Hospital Universitario 12 de Octubre, Madrid, Spain
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12
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Abstract
We report the case of an adolescent boy who presented with hypertension and hypokalemia. A systematic work-up revealed hyperreninemic hyperaldosteronism. Further study revealed Page kidney caused by trauma-associated renal hematoma. The evaluation and management of hyperaldosteronism and Page kidney are discussed.
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Affiliation(s)
- Brenda Shome
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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13
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Finelli A, Rasul I, Keystone J, Bargman JM. Development of severe secondary hypertension in a patient with systemic entomophthoromycosis. Am J Kidney Dis 1997; 29:620-3. [PMID: 9100054 DOI: 10.1016/s0272-6386(97)90347-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The sudden onset of hypertension mandates investigation for secondary causes. We report the case of a young man with a very rare systemic fungal disease that included massive unilateral perirenal adenopathy. Treatment was associated with the abrupt onset of severe hypertension. Imaging studies suggested progressive constriction of one kidney with treatment, presumably as a result of healing adenopathy. We suggest that this case is a new example of hypertension secondary to constrictive perinephritis (Page kidney).
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Affiliation(s)
- A Finelli
- Division of Nephrology, Toronto Hospital, Canada
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14
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Abstract
Chronic renal failure caused by hypertension or by parenchymal kidney disease is a very common global health problem. Patients with chronic renal failure have two therapeutic options, dialysis and transplantation, of which transplantation has become a preferred modality. This review article is an update of a more comprehensive previous review (Semin Nucl Med, 181-198, 1988) and concentrates on the changes that have taken place in this field in recent years. These changes comprise new criteria for the selection of transplant candidates, newer techniques for the diagnosis of medical and surgical complications after transplantation, the use of new tracers (Tc-99m MAG3), and new antirejection regimens.
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Affiliation(s)
- E V Dubovsky
- Division of Nuclear Medicine, University of Alabama Hospital, Birmingham 35233-6835, USA
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15
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Abstract
Page kidney is caused by the accumulation of blood in the perinephric or subcapsular space, resulting in compression of the involved kidney, renal ischemia, and high renin hypertension. Most patients are young hypertensives with a remote history of blunt trauma to the abdomen or back. We describe a case of acute Page kidney following a renal biopsy in a patient with underlying IgA nephropathy. In addition to the new-onset hypertension, this patient developed a significant decline in renal function due to the inability of the contralateral diseased kidney to compensate. Magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound were valuable in making this diagnosis. Medical and surgical therapeutic options were considered. This report also reviews all previously described cases of Page kidney.
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Affiliation(s)
- T R McCune
- Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN 37232-2372
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16
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Lemann J, Taylor AJ, Collier BD, Lipchik EO. Kidney hematoma due to extracorporeal shock wave lithotripsy causing transient renin mediated hypertension. J Urol 1991; 145:1238-41. [PMID: 2033701 DOI: 10.1016/s0022-5347(17)38587-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- J Lemann
- Department of Medicine, Medical College of Wisconsin, Milwaukee
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