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Kumarasinghe G, Sivasubramanium M, Ekanayake KB, Rambukwella D, Sanjaya B. A fatal misdiagnosis of page kidney - case report. Forensic Sci Med Pathol 2024; 20:1553-1557. [PMID: 38613623 DOI: 10.1007/s12024-024-00807-6] [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] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
Page kidney is a condition where external compression of the renal artery and renal parenchyma leads to subsequent ischaemia and activation of renin-angiotensin-aldosterone axis. A 42-year-old female with hirsutism, hypertension and diabetes was diagnosed with a right adrenal mass and underwent laparoscopic adrenalectomy. Her hypertension worsened postoperatively and was managed medically. Subsequently she developed a right flank pain on the fifth postoperative day and died suddenly the next day. Autopsy revealed a pale body with cushingoid appearance. Surgical scars were healthy. Internal examination of the abdomen revealed a haemoperitoneum of 500 ml together with a large subcapsular haematoma measuring 1000 ml surrounding the right kidney, compressing the right renal artery. Kidneys were pale and the right kidney was soft and friable. Cortical surface of the right kidney demonstrated a possible surgical puncture site with an overlying thrombus together with a contused inferior vena cava. Other organs were pale but appeared otherwise normal. Histology revealed diffuse cortical necrosis of right kidney and features of adult respiratory distress syndrome in the lungs. Haemorrhagic shock following laparoscopic adrenalectomy for right adrenal tumor was declared as the cause of death, contributed by the development of the Page kidney. Trauma of several aetiologies including laparoscopic abdominal surgery may contribute to Page kidney. It presents with flank pain, hypertension and renal mass. Since postoperative blood loss usually manifests as hypotension, resulting hypertension may mislead the attending clinicians. Once diagnosed, it can be managed with surgical drainage and antihypertensives.
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Affiliation(s)
- Gayan Kumarasinghe
- Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | | | - Kasun Bandara Ekanayake
- Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Bandarage Sanjaya
- Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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2
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Nishio H, Mizuno K, Sakata T, Matsumoto D, Kamisawa H, Kurokawa S, Nakane A, Maruyama T, Yasui T, Hayashi Y. Page kidney in a child with ureteropelvic junction obstruction of lower moiety in a partial duplex system. Urol Case Rep 2024; 57:102880. [PMID: 39583333 PMCID: PMC11585647 DOI: 10.1016/j.eucr.2024.102880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 10/29/2024] [Accepted: 11/05/2024] [Indexed: 11/26/2024] Open
Abstract
Reports of hydronephrosis-induced hypertension in pediatric patients are rare. A 7-year-old girl with hypertension was referred to our hospital with left hydronephrosis caused by ureteropelvic junction obstruction of the lower moiety in a partial duplex system. Because the lower moiety was almost nonfunctional, a laparoscopic heminephrectomy was performed. Antihypertensive drugs were unnecessary on the day after surgery. This is the first report of a Page kidney in a patient with ureteropelvic junction obstruction of the lower moiety. The cause of hypertension was evaluated based on the plasma renin activity and pathological findings of the lower moiety.
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Affiliation(s)
- Hidenori Nishio
- Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kentaro Mizuno
- Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takuya Sakata
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Daisuke Matsumoto
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hideyuki Kamisawa
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoshi Kurokawa
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akihiro Nakane
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tetsuji Maruyama
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yutaro Hayashi
- Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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3
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Koyanagawa K, Bahl S, Havryliuk T. A Rare Case of Page Kidney in a Young Man with Flank Pain. J Emerg Med 2024; 66:e369-e373. [PMID: 38278675 DOI: 10.1016/j.jemermed.2023.10.019] [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: 08/02/2023] [Revised: 09/03/2023] [Accepted: 10/01/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Page kidney is a rare condition in which an external compression of the kidney as a result of a hematoma or mass causes renal ischemia and hypertension. In a patient with flank pain, elevated blood pressure, and recent trauma, this condition should be considered. Since this condition was first described in 1939, more than 100 case reports have surfaced. CASE REPORT We describe the case of a 26-year-old man who presented to the Emergency Department with flank pain, vomiting, and elevated blood pressure. A computed tomography scan of the abdomen and pelvis confirmed the presence of a perinephric hematoma, and the interventional radiology team was consulted to resolve the Page kidney. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Symptoms seen in Page kidney may be similar to other more common diagnoses encountered in the emergency department. It is important to maintain a high suspicion and order imaging studies as needed, especially in the setting of trauma, or a recent procedure in the vicinity of the renal parenchyma.
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Affiliation(s)
| | - Sumeet Bahl
- Department of Interventional Radiology, The Brooklyn Hospital Center, Brooklyn, New York
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Zaw E, Bies JJ, Zay H, Massebo E, Hassan M, Prakash S, Htay T, Lane M. A Rare Case of Page Kidney With Superimposed Infection. Cureus 2023; 15:e50842. [PMID: 38249211 PMCID: PMC10798362 DOI: 10.7759/cureus.50842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
Page kidney (PK) is a rare renal condition characterized by external compression of the kidney, typically by a subcapsular hematoma, leading to resistant secondary hypertension due to hypoperfusion and ischemia. This hypertension is caused by the external compression of the kidney by a chronic subcapsular hematoma that activates the renin-angiotensin-aldosterone system (RAAS) system. Hematoma formation can result from external or internal trauma. The resolution of the hematoma can take months, and, in some cases, may necessitate a nephrectomy. Unresolved subcapsular hematomas can be complicated by infection, leading to sepsis, hospitalization, and the need for surgical drainage. This report presents a unique case of a 67-year-old female with a spontaneous left renal subcapsular hematoma that did not resolve with conservative measures and was complicated by superimposed infection requiring percutaneous drainage.
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Affiliation(s)
- Emerald Zaw
- Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA
| | - Jared J Bies
- Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA
| | - Hein Zay
- Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA
| | - Eyoab Massebo
- Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA
| | - Mariam Hassan
- Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA
| | - Swathi Prakash
- Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA
| | - Thwe Htay
- Medical Education, Texas Tech University Health Sciences Center El Paso, El Paso, USA
| | - Mariela Lane
- Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA
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5
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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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6
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Meilstrup A, Clay K, Burkenstock A. Hypertensive Emergency in a Spontaneous Page Kidney. Cureus 2023; 15:e41789. [PMID: 37575746 PMCID: PMC10421644 DOI: 10.7759/cureus.41789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 08/15/2023] Open
Abstract
Page kidney or Page phenomenon is a rare cause of hypertension that results from external compression of the kidney and renin-angiotensin-aldosterone system activation. Most cases involve trauma as the precipitating factor. Page kidney can result in severe and resistant hypertension that can be challenging to treat. We present a unique case: a patient in hypertensive emergency secondary to Page kidney caused by a spontaneous subcapsular renal hematoma.
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Affiliation(s)
- Asha Meilstrup
- School of Medicine, University of Mississippi Medical Center, Jackson, USA
| | - Kyle Clay
- Department of Medicine, University of Mississippi Medical Center, Jackson, USA
| | - Austin Burkenstock
- Department of Medicine, G. V. (Sonny) Montgomery VA (Veteran Affairs) Medical Center, Jackson, USA
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7
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Renal Lymphangiomatosis. Indian J Pediatr 2023; 90:406-407. [PMID: 36790575 DOI: 10.1007/s12098-023-04486-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 01/12/2023] [Indexed: 02/16/2023]
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8
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Thammathiwat T, Suwannasrisuk P, Sirilak S. Hypertension in a Young Man with an Abdominal Mass. KIDNEY360 2023; 4:e564-e565. [PMID: 37103963 PMCID: PMC10371364 DOI: 10.34067/kid.0000000000000084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 04/28/2023]
Affiliation(s)
- Theerachai Thammathiwat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Preaw Suwannasrisuk
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Supinda Sirilak
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
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Cisneros R, Nair A, Kashyap R, Pineda-Solis K. Page phenomenon in a transplanted kidney: is it salvageable? BMJ Case Rep 2022; 15:e249625. [PMID: 36162963 PMCID: PMC9516073 DOI: 10.1136/bcr-2022-249625] [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] [Accepted: 09/17/2022] [Indexed: 11/03/2022] Open
Abstract
A male in his late 70s with a history of an uncomplicated kidney transplantation 20 years prior was brought to the Emergency Department after experiencing blunt abdominal trauma following a motor vehicle collision. Imaging revealed a large perinephric haematoma, a retroperitoneal haematoma and multiple fractures. He was admitted to the intensive care unit where a renal haematoma was found to be expanding with ultrasonography (US) and developed renal dysfunction including anuria and hyperkalemia. His creatinine rose to twice his baseline and Doppler US showed elevated resistive indices, confirming extrinsic compression and causing a Page phenomenon. An open surgical exploration through the upper aspect of his Gibson incisional scar was performed followed by evacuation of the haematoma. An intraoperative US was done demonstrating good flow in the renal vessels. His postoperative course was uncomplicated and was discharged home with renal function back to baseline. On follow-up, he continued to have a good renal function.
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Affiliation(s)
- Rafael Cisneros
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Amit Nair
- Transplant Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Randeep Kashyap
- Transplant Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Karen Pineda-Solis
- Transplant Surgery, University of Rochester Medical Center, Rochester, New York, USA
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10
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Kambayashi Y, Iseri K, Yamamoto Y, Abe M, Wada Y, Yanai R, Honda H. Bilateral renal subcapsular hematoma caused by polyarteritis nodosa: a case report. CEN Case Rep 2022; 11:399-403. [PMID: 35171449 DOI: 10.1007/s13730-022-00691-5] [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: 10/04/2021] [Accepted: 02/03/2022] [Indexed: 11/25/2022] Open
Abstract
Polyarteritis nodosa, which is a systemic vasculitis of small- and medium-sized arteries, can cause arterial aneurysms in various organs, sometimes resulting in aneurysm rupture and hemorrhage. A kidney is one of the major targets of polyarteritis nodosa. Here, we report a 73-year-old woman who presented with sudden-onset high fever, diarrhea, and renal injury with bilateral renal subcapsular hematoma shown on contrast-enhanced computed tomography scan. She did not have trauma and significant medical history other than breast cancer in remission. Serological and immunological tests except for anti-Sjögren's syndrome-A and anti-Sjögren's syndrome-B were all negative. Digital subtraction angiography revealed bilateral intrarenal micro aneurysms, which allowed us to diagnose the patient with polyarteritis nodosa. As continuous monitoring of bilateral intrarenal hematoma by ultrasonography and computed tomography scan did not detect progression of intrarenal hemorrhage and extra renal hematoma, transcatheter arterial embolization and nephrectomy were not performed. Although hemodialysis therapy was required temporarily for acute kidney injury with anuria, her general condition and kidney function remarkably improved after receiving systemic immunosuppressive therapy with corticosteroids and cyclophosphamide. In conclusion, this is a rare case of polyarteritis nodosa manifesting as spontaneous bilateral subcapsular renal hemorrhage with deteriorated renal function, which was successfully treated with immunosuppressive therapy.
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Affiliation(s)
- Yui Kambayashi
- Department of Medicine, Division of Nephrology, Showa University School of Medicine, Tokyo, Japan.
| | - Ken Iseri
- Department of Medicine, Division of Nephrology, Showa University School of Medicine, Tokyo, Japan
| | - Yasutaka Yamamoto
- Department of Medicine, Division of Nephrology, Showa University School of Medicine, Tokyo, Japan
| | - Maki Abe
- Department of Medicine, Division of Nephrology, Showa University School of Medicine, Tokyo, Japan
| | - Yukihiro Wada
- Department of Medicine, Division of Nephrology, Showa University School of Medicine, Tokyo, Japan
| | - Ryo Yanai
- Department of Medicine, Division of Rheumatology, Showa University School of Medicine, Tokyo, Japan
| | - Hirokazu Honda
- Department of Medicine, Division of Nephrology, Showa University School of Medicine, Tokyo, Japan
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11
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Neela N, Taha H, Kala J. Spontaneous Page kidney from ruptured renal angiomyolipoma. Proc (Bayl Univ Med Cent) 2021; 34:689-690. [PMID: 34732988 DOI: 10.1080/08998280.2021.1948736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Renal angiomyolipomas are the most common benign tumors of the kidneys. They are prone to rupture, which may result in massive hemorrhage and often requires lifesaving nephrectomy. Delay in treatment is likely to result in death. We report two cases of ruptured angiomyolipoma compressing the renal parenchyma, causing secondary hypertension (Page kidney). Both patients presented with abdominal pain, hypertension, and reduced or dropping hemoglobin counts. The delay in diagnosis and treatment resulted in their adverse outcomes. We highlight the need to promptly diagnose and treat symptomatic renal hematomas to avoid subsequent morbidity and mortality.
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Affiliation(s)
- Niharika Neela
- Department of Internal Medicine, University of Texas Health Science Center-McGovern Medical School, Houston, Texas
| | - Hula Taha
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center-McGovern Medical School, Houston, Texas
| | - Jaya Kala
- Department of Internal Medicine, University of Texas Health Science Center-McGovern Medical School, Houston, Texas
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12
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Douvris A, Jegatheswaran J, Hadziomerovic A, Ruzicka M. Page kidney: Rare cause of acute kidney injury after complicated renal artery angioplasty. J Clin Hypertens (Greenwich) 2021; 23:1631-1633. [PMID: 34216535 PMCID: PMC8678673 DOI: 10.1111/jch.14318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/29/2022]
Abstract
The authors present a case of a patient who experienced a rare complication after attempted renal angioplasty and stenting, Page kidney. This patient presented with new onset hypertension secondary to bilateral renal artery stenosis and was referred for revascularization given hypertension refractory to medical management. The right renal artery underwent successful angioplasty and stenting; however, the left renal artery experienced recoil stenosis. Post‐procedure the patient developed acute kidney injury secondary to Page kidney from subcapsular and extracapsular hematoma. This was managed conservatively with transfusions and the hematoma and acute kidney injury self‐resolved over the next 4 months. This case highlights the importance of revascularization for refractory hypertension secondary to hemodynamically significant bilateral renal artery stenosis, the rare complication of Page kidney with attempted revascularization of renal artery stenosis and the involvement of a hypertension specialist in the decision of revascularization of renal artery stenosis.
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Affiliation(s)
- Adrianna Douvris
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Januvi Jegatheswaran
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Adnan Hadziomerovic
- Division of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Marcel Ruzicka
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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13
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Endo N, Shimizu H, Tanaka T, Nakase Y, Kawazoe T, Watanabe T. Rapidly Progressive Kidney Failure Associated with Perirenal Capsular Lesion Due to IgG4-Related Disease. Intern Med 2021; 60:1893-1897. [PMID: 33456038 PMCID: PMC8263170 DOI: 10.2169/internalmedicine.6232-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 71-year-old Japanese man with progressive kidney failure was referred to our hospital. Laboratory tests showed elevated IgG4 levels. Contrast-enhanced computed tomography (CT) revealed soft tissue surrounding the left kidney and right atrophic kidney. A histopathological examination revealed inflammation and fibrosis with rich IgG4-positive cells in the thickened kidney capsule, but not in the kidney parenchyma. Poor enhancement in the left kidney on contrast-enhanced CT and wrinkling of glomerular capillaries in pathological tissues were also observed. These findings indicated IgG4-related perirenal lesions leading to low renal perfusion and kidney failure. The perirenal lesions and kidney failure were improved by corticosteroid therapy.
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Affiliation(s)
- Nobuhide Endo
- Department of Nephrology, Japanese Red Cross Nagoya Daiichi Hospital, Japan
| | - Hitomi Shimizu
- Department of Nephrology, Japanese Red Cross Nagoya Daiichi Hospital, Japan
| | - Tomoki Tanaka
- Department of Nephrology, Japanese Red Cross Nagoya Daiichi Hospital, Japan
| | - Yukiko Nakase
- Department of Nephrology, Japanese Red Cross Nagoya Daiichi Hospital, Japan
| | - Tomohiro Kawazoe
- Department of Nephrology, Japanese Red Cross Nagoya Daiichi Hospital, Japan
| | - Tomoharu Watanabe
- Department of Nephrology, Japanese Red Cross Nagoya Daiichi Hospital, Japan
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14
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Izekor BE, Odigwe C, Goraya N, Duran PA. Page Kidney From a Subcapsular Urinoma Following Contralateral Radical Nephrectomy. Cureus 2021; 13:e15639. [PMID: 34150415 PMCID: PMC8202125 DOI: 10.7759/cureus.15639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Page kidney is a rare cause of hypertension and kidney injury; it results from extrinsic compression of the kidney due to fluid accumulation in the subcapsular space. Hypertensive crisis may be the only presenting clinical sign in patients with Page kidney. Urinomas are a very rare cause of Page kidney with very few cases reported in the literature. Urinoma should be suspected in patients presenting in hypertensive crisis who have a history of recent abdominal trauma, genitourinary malignancy, and renal instrumentation. Patients diagnosed with Page kidney from a urinoma should be managed with the least invasive means possible.
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Affiliation(s)
- Bright E Izekor
- Internal Medicine, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Chidozie Odigwe
- Nephrology, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Nimrit Goraya
- Nephrology, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Paula A Duran
- Nephrology, Baylor Scott & White Medical Center - Temple, Temple, USA
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15
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Canllavi E, Teigell J, Trujillo H, Gutiérrez E, Sánchez A, Miranda-Utrera N, Morales E. Acute Page kidney after angioplasty in kidney transplant allografts. Clin Kidney J 2021; 14:1980-1982. [PMID: 34345423 PMCID: PMC8323144 DOI: 10.1093/ckj/sfab064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/15/2021] [Indexed: 11/28/2022] Open
Abstract
Acute Page kidney (APK) in kidney transplantation is a rare entity often related to interventional techniques. Percutaneous angioplasty remains an exceptional cause of APK. Herein we describe the clinical course and outcome of APK following percutaneous angioplasty for transplant renal artery stenosis in four kidney transplant recipients, where external compression of the graft was caused by subcapsular haematomas. All patients were treated with surgical drainage, after which two cases recovered baseline kidney function, one developed advanced chronic kidney disease and one remained dialysis-dependent. To our knowledge, the present series is the largest to describe APK in kidney allografts after percutaneous angioplasty.
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Affiliation(s)
- Elizabeth Canllavi
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Julio Teigell
- Department of Urology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Hernando Trujillo
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Eduardo Gutiérrez
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain.,Instituto de Investigación del Hospital Universitario 12 de Octubre (imas12), Madrid, Spain
| | - Angel Sánchez
- Department of Radiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Enrique Morales
- Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain.,Instituto de Investigación del Hospital Universitario 12 de Octubre (imas12), Madrid, Spain.,Department of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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16
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Onuigbo MAC, Sharma V, Balogun O, Ghimire A. Page Kidney Complicating Kidney Biopsy after Stopping Apixaban: A Physician's Dilemma. Indian J Nephrol 2020; 30:201-203. [PMID: 33013072 PMCID: PMC7470205 DOI: 10.4103/ijn.ijn_269_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 09/05/2019] [Accepted: 10/10/2019] [Indexed: 12/17/2022] Open
Abstract
Page kidney was described by Page, following very elaborate experiments with animal kidneys in 1939, with persistent arterial hypertension from "cellophane perinephritis." Subsequently, it was reported after trauma, from renal cysts and tumors, and from intrarenal hematoma complicating percutaneous kidney biopsy. We describe Page kidney associated with acute kidney injury 26 days after an uncomplicated ultrasound-guided right native kidney biopsy. Patient was on Apixaban, a non-vitamin K antagonist oral anticoagulant (NOAC) for atrial fibrillation which was withheld 3 days before the procedure. It was restarted 3 days after. The evidence-base supporting guidelines and recommendations for the peri-procedural management of the NOACs is inadequate, sparse, and often conflicted. More research is warranted.
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Affiliation(s)
- Macaulay A C Onuigbo
- Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Vivek Sharma
- Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Omotola Balogun
- Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Allina Ghimire
- Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
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Feit L, John D, Delgado Torres N, Sinert R. Flank pain and hematuria is not always a kidney stone. Am J Emerg Med 2020; 40:225.e1-225.e2. [PMID: 32958382 DOI: 10.1016/j.ajem.2020.07.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/17/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients with flank pain and hematuria are common emergency department presentations of nephrolithiasis. We may anchor on this etiology and potentially miss other less common differentials. We present a case of a patient with hematuria and flank pain typical of nephrolithiasis who was diagnosed with a Page kidney causing secondary hypertension. A 50 year-old male with no significant past medical history presented to the Emergency Department with severe left-sided flank pain, vomiting, and blood-tinged urine. We pursued a diagnosis of nephrolithiasis and found a left renal subcapsular hematoma on non-contrast CT. A CTA was done with no active hemorrhage found. The patient had no history of recent trauma and was found to be hypertensive on evaluation. Urology was consulted and management for the patient's hypertension was initiated. He was diagnosed with Page Kidney and admitted to medicine for observation and hypertension management with an angiotensin-converting enzyme inhibitor. Page Kidney is a diagnosis that describes compression of the renal parenchyma by a hematoma or mass causing secondary hypertension through the activation of the renin-angiotensin-aldosterone system. Causes may include traumatic subcapsular hematoma, renal cyst rupture, tumor, hemorrhage, arteriovenous malformation, among others. Treatment may involve conservative measures including hypertension management, or more invasive measures like evacuation or nephrectomy. We describe the case of a patient presumed to have nephrolithiasis presenting with typical left-sided flank pain, diagnosed with Page kidney, and treated conservatively.
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Affiliation(s)
- Lisa Feit
- State University of New York Downstate Medical Center, 450 Clarkson Avenue Brooklyn, New York 11203, USA; Kings County Hospital New York Health and Hospitals, 451 Clarkson Avenue Brooklyn, New York 11203, USA.
| | - Delna John
- State University of New York Downstate Medical Center, 450 Clarkson Avenue Brooklyn, New York 11203, USA; Kings County Hospital New York Health and Hospitals, 451 Clarkson Avenue Brooklyn, New York 11203, USA
| | - Nayla Delgado Torres
- State University of New York Downstate Medical Center, 450 Clarkson Avenue Brooklyn, New York 11203, USA; Kings County Hospital New York Health and Hospitals, 451 Clarkson Avenue Brooklyn, New York 11203, USA
| | - Richard Sinert
- State University of New York Downstate Medical Center, 450 Clarkson Avenue Brooklyn, New York 11203, USA; Kings County Hospital New York Health and Hospitals, 451 Clarkson Avenue Brooklyn, New York 11203, USA
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18
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Page Kidney in a Child with Severe Pelviureteric Junction Obstruction. Case Rep Urol 2020; 2020:8883546. [PMID: 32884853 PMCID: PMC7455810 DOI: 10.1155/2020/8883546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/27/2020] [Accepted: 07/14/2020] [Indexed: 11/29/2022] Open
Abstract
There are various causes of Reno Vascular Hypertension in children reported in the literature. Amongst these, Page kidney gets a rare mention. This phenomenon is a result of the accumulation of blood or urine in the perinephric or subcapsular space, resulting in compression of renal parenchyma, microvascular ischemia, alteration in the renin-angiotensin apparatus, and high renin hypertension. It has been well documented and studied in adults. Only a few cases are reported in the paediatric population. We report a rare presentation of Page kidney in a 5 year 8 months old girl. She initially presented with Dietl's crisis secondary to left Pelviureteric Junction obstruction (PUJO) causing massive hydronephrosis. She developed Page kidney phenomenon after spontaneous rupture of the pelvicalyceal system formed a tight compressive urinoma. She was managed successfully with internal JJ stenting and ultrasound-guided aspiration of the urinoma followed by elective delayed Pyeloplasty. To our knowledge, this is the first documented case of Page kidney in a child with severe PUJO.
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Incidence and Risk Factors of Hypertension Following Partial Nephrectomy in Patients With Renal Tumors: A Cross-sectional Study of Postoperative Home Blood Pressure and Antihypertensive Medications. Clin Genitourin Cancer 2020; 18:e619-e628. [PMID: 32144048 DOI: 10.1016/j.clgc.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/01/2020] [Accepted: 02/02/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION We aimed to evaluate the incidence and risk factors for nephrectomy-related hypertension (NR-HT) in patients with renal tumors who underwent partial nephrectomy (PN) or radical nephrectomy (RN). PATIENTS AND METHODS A retrospective cross-sectional follow-up survey of postoperative home blood pressure (BP) and defined daily dose (DDD) of antihypertensive medications was conducted in patients with renal tumors who underwent PN (210 patients) or RN (120 patients), and they were compared. We evaluated the incidence and risk factors for NR-HT, defined as the addition of antihypertensive medications in doses of 1 DDD or more after surgery, or postoperative BP of 140/90 mmHg with an increase of 20 mmHg from preoperative BP with no reduction in dose of antihypertensive medications. RESULTS Both systolic (mean, 124 vs. 129 mmHg; P < .001) and diastolic BP (mean, 74 vs. 79 mmHg; P < .001) significantly increased after PN compared with RN. Systolic (P < .001) and diastolic (P = .003) BP increased significantly more after PN than after RN, and NR-HT was more frequent after PN than after RN (16% vs. 5%; P = .002). PN (odds ratio [OR], 2.93; P = .022) and higher postoperative peak C-reactive protein (OR, 2.34; P = .017) were independently associated with NR-HT. When limited to only the patients who underwent PN, acute kidney injury (OR, 2.65; P = .036) and higher postoperative peak C-reactive protein (OR, 2.54; P = .016) were independent risk factors for NR-HT. CONCLUSION PN may cause postoperative progression of hypertension possibly through renal parenchymal damage.
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Onuigbo MAC, Sharma V, Balogun OO, Ghimire A. Post-Renal Biopsy Acute Kidney Injury and Page Kidney from Intra-Renal Hematoma Aggravated by Reversible Contrast-Induced Nephropathy Following Renal Arterial Embolization. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e919701. [PMID: 31964858 PMCID: PMC6998796 DOI: 10.12659/ajcr.919701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Patient: Male, 73-year-old Final Diagnosis: Page kidney from intra-renal hematoma aggravated by reversible contrast-induced nephropathy following renal arterial embolization Symptoms: Flank pain • nausea • vomiting Medication: Apixaban Clinical Procedure: Kidney biopsy and subsequent renal arterial embolization Specialty: Nephrology
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Affiliation(s)
- Macaulay A Chukwukadibia Onuigbo
- Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Vivek Sharma
- Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Omotola O Balogun
- Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Allina Ghimire
- Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
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21
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Chen HH, Wu ST, Lin YC, Lin CS. Synchronous renal cell carcinoma and pheochromocytoma presenting as acute decompensated heart failure. J Postgrad Med 2019; 65:44-46. [PMID: 30693873 PMCID: PMC6380140 DOI: 10.4103/jpgm.jpgm_701_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a 49-year-old woman who presented with a hypertensive crisis and acute heart failure and reduced left ventricular systolic function. An abdominal ultrasonography revealed a huge lobulated heterogeneous mass at the lower pole of the right kidney and a mass over the left suprarenal area, which were further delineated by magnetic resonance imaging. The patient underwent laparoscopic right radical nephrectomy and left adrenalectomy. Histopathological analysis confirmed the diagnoses of clear cell renal cell carcinoma of the right kidney with metastasis to the lung; and atypical pheochromocytoma of the left adrenal gland. Target therapy was initiated, which resulted in stabilization of the patient's tumors and the recovery of her heart function. To avoid a delayed diagnosis and catastrophic outcome, clinicians should consider such rare causes of acute decompensated heart failure.
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Affiliation(s)
- H H Chen
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - S T Wu
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Y C Lin
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - C S Lin
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Page kidney as a complication after a shock wave lithotripsy: a case report. CEN Case Rep 2018; 7:330-331. [PMID: 30159710 DOI: 10.1007/s13730-018-0361-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/19/2018] [Indexed: 10/28/2022] Open
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McFadden JD, Hawksworth JS. Page Kidney: An Unusual Complication of a Renal Transplant Biopsy. Case Rep Urol 2018; 2018:8768549. [PMID: 29854553 PMCID: PMC5941725 DOI: 10.1155/2018/8768549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/14/2018] [Indexed: 11/18/2022] Open
Abstract
Page kidney, a rare phenomenon whereby external compression of renal parenchyma can induce hypertension, can be caused by subcapsular hematoma following renal transplant biopsy. Surgical intervention is often warranted to salvage the transplant kidney. This is a case report of a patient with acute T-cell-mediated rejection and no other risk factors for postprocedural bleeding that developed Page kidney. The patient had no signs or symptoms for >24 hours from the time of biopsy, underscoring the need for awareness of this rare but potentially catastrophic complication of renal transplant biopsies.
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Affiliation(s)
- Jacob D. McFadden
- Department of Transplant Surgery and Department of Urology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD, USA
| | - Jason S. Hawksworth
- Department of Transplant Surgery and Department of Urology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD, USA
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Zvavanjanja RC, Ashton AS. Page kidney secondary to subcapsular hematoma following percutaneous renal allograft biopsy. Radiol Case Rep 2018; 13:702-708. [PMID: 30046367 PMCID: PMC6056706 DOI: 10.1016/j.radcr.2018.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/18/2018] [Indexed: 02/04/2023] Open
Abstract
Percutaneous renal biopsy with ultrasound guidance is a helpful procedure regularly performed to obtain renal tissue diagnosis for rejection in the postrenal transplant setting; however, it is not without risks. We report the case of a 42-year-old male with end stage renal disease who developed a subcapsular hematoma, with subsequent hypertension and renal failure, compatible with acute page kidney as a complication of the renal biopsy. The ultrasound images demonstrated classic imaging appearances which all diagnostic and interventional radiologists should be aware of. The patient was managed successfully with conventional open surgical evacuation of the hematoma with return to baseline laboratories and vital signs after the procedure.
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Chiu YL, Hu C, Lee SD, Chen PY, Wang CP. The role of renoscintigraphy and surgery in the management of Page kidney: A case report. Medicine (Baltimore) 2017; 96:e6560. [PMID: 28422842 PMCID: PMC5406058 DOI: 10.1097/md.0000000000006560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Page kidney is an uncommon condition that hypertension occurs secondary to microvascular ischemia and alternation of small-vessel hemodynamics due to external compression of renal parenchyma and activation of the renin-angiotensin-aldosterone system. There are no specific guidelines for the management of Page kidney in the literatures. PATIENT CONCERNS A 17-year-old teenager who had Fontan procedure for tricuspid and pulmonary atresia in early childhood suffered from sudden onset of severe left flank pain during cardiac catheterization procedure. Left renal artery active bleeding with renal parenchyma compression in association with renin-mediated hypertension led to the diagnosis of Page kidney. DIAGNOSES Page kidney was diagnosed in this case. INTERVENTIONS Urgent embolization was performed to treat left renal artery active bleeding. Because of decreased renal function with elevation of serum creatinine, inadequate blood pressure control with antihypertensive medication, and poor renal blood flow of left kidney, open drainage of perirenal hematoma was done 5 days after catheterization procedure. OUTCOMES After the operation, glomerular filtration rate improved immediately, and left flank pain and hypertension resolved at discharge. LESSONS The choice of the therapies for Page kidney depended on the clinical presentation of each case. This case pointed out the significance of renoscintigraphy and surgery in the management of Page kidney.
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Affiliation(s)
- Yu-Li Chiu
- aDepartment of Nuclear Medicine bSection of Pediatric Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Taiwan
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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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27
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Araújo NC, Suassuna JHR. Reversed Diastolic Flow in Page Kidney Following Native Kidney Biopsy. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/8756479316667078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Page kidney phenomenon occurs due to external compression of a kidney by either subcapsular or perinephric hematoma, tumor, lymphocele, or urinoma. This article describes a case of reversed diastolic arterial flow on Doppler insonation in a Page kidney due to external compression as a consequence of native kidney biopsy-induced perinephric hematoma. Reversed diastolic arterial flow has already been reported in Page kidney in renal allografts; however, we are not aware of any report of such a finding in a native kidney. This report highlights the importance of being aware of the possible occurrence of the reversion of the diastolic flow in Doppler sonography in Page kidney, even though it is rare. Moreover, this case illustrates the short but severe impact of Page kidney on renal function and suggests that a conservative approach is an effective treatment option even in a moderate to severe perinephric hematoma.
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28
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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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29
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Wahdat R, Schwartz C, Espinosa J, Lucerna A. Page kidney: taking a page from history. Am J Emerg Med 2016; 35:193.e1-193.e2. [PMID: 27439385 DOI: 10.1016/j.ajem.2016.06.095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 06/29/2016] [Indexed: 11/30/2022] Open
Affiliation(s)
- Razwana Wahdat
- Department of Emergency Medicine, Rowan University SOM Kennedy University Hospital, Stratford, NJ, USA.
| | - Christopher Schwartz
- Department of Emergency Medicine, Rowan University SOM Kennedy University Hospital, Stratford, NJ, USA
| | - James Espinosa
- Department of Emergency Medicine, Rowan University SOM Kennedy University Hospital, Stratford, NJ, USA
| | - Alan Lucerna
- Department of Emergency Medicine, Rowan University SOM Kennedy University Hospital, Stratford, NJ, USA
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30
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Kobel MC, Nielsen TK, Graumann O. Acute renal failure and arterial hypertension due to subcapsular haematoma: is percutaneous drainage a feasible treatment? BMJ Case Rep 2016; 2016:bcr-2015-212769. [PMID: 26783007 DOI: 10.1136/bcr-2015-212769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Percutaneous drainage proved to be successful in managing a renal subcapsular haematoma that was causing acute renal failure and hypertension in a 74-year-old woman. The patient presented with oliguria, nausea and malaise 2 days after a ureteronephroscopic procedure with biopsies of a suspected urothelial neoplasm in the right renal pelvis. The left kidney had recently been removed due to renal cell carcinoma. At admission, the patient's blood pressure and plasma creatinine levels were massively elevated. Ultrasonography revealed a moderate right-sided renal subcapsular haematoma. When the patient did not respond to antihypertensive treatment, Page kidney was suspected. A pigtail catheter was placed in the haematoma and, shortly after drainage, the diuresis resumed and plasma creatinine together with blood pressure decreased. This condition had previously been managed by open surgery, but recent case reports have described successful management by laparoscopy-assisted and radiology-assisted drainage, as described in this case report.
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Affiliation(s)
| | | | - Ole Graumann
- Department of Radiology, Aarhus University Hospital, Aarhus N, Denmark
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32
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Hall M. Expert's comment concerning Grand Rounds case entitled "Posterior lumbar fixation in a kidney transplant recipient-logistics and perioperative challenges" (Marcin Czyz, Sibylle Jürgens, Keith M. Rigg, Marrie O'Connor, Bronek M. Boszczyk). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24:2336-2338. [PMID: 26153677 DOI: 10.1007/s00586-015-4087-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 06/18/2015] [Accepted: 06/18/2015] [Indexed: 06/04/2023]
Affiliation(s)
- Matt Hall
- Nottingham University Hospitals, Nottingham, UK.
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33
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Hogan JJ, Mocanu M, Berns JS. The Native Kidney Biopsy: Update and Evidence for Best Practice. Clin J Am Soc Nephrol 2015; 11:354-62. [PMID: 26339068 DOI: 10.2215/cjn.05750515] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The kidney biopsy is the gold standard in the diagnosis and management of many diseases. Since its introduction in the 1950s, advancements have been made in biopsy technique to improve diagnostic yield while minimizing complications. Here, we review kidney biopsy indications, techniques, and complications in the modern era. We also discuss patient populations in whom special consideration must be given when considering a kidney biopsy and the important role that the kidney biopsy plays in nephrology training. These data are presented to develop best practice strategies for this essential procedure.
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Affiliation(s)
- Jonathan J Hogan
- Department of Medicine, Division of Nephrology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michaela Mocanu
- Department of Medicine, Division of Nephrology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey S Berns
- Department of Medicine, Division of Nephrology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Çiftçi S, Stuart Wolf J. Laparoscopic treatment of Page kidney: a report of two cases and review of the literature. Turk J Urol 2015; 39:126-30. [PMID: 26328095 DOI: 10.5152/tud.2013.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 08/28/2012] [Indexed: 12/28/2022]
Abstract
Page kidney is defined as the external compression of the kidney, typically by a subcapsular hematoma, that leads to hypertension due to hypoperfusion and ischemia. The treatment options include medical anti-hypertensive treatment, percutaneous drainage, surgical decortication and nephrectomy. Laparoscopic decortication of Page kidney is a newly defined minimally invasive management technique. We describe 2 cases of Page kidney that failed to improve with percutaneous drainage but were successfully treated with the laparoscopic approach.
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Affiliation(s)
- Seyfettin Çiftçi
- Department of Urology, University of Michigan Health System, MI, USA
| | - J Stuart Wolf
- Department of Urology, University of Michigan Health System, MI, USA
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35
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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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Kozminski MA, Kozminski DJ, Roberts WW, Faerber GJ, Hollingsworth JM, Wolf JS. Symptomatic Subcapsular and Perinephric Hematoma Following Ureteroscopic Lithotripsy for Renal Calculi. J Endourol 2015; 29:277-82. [DOI: 10.1089/end.2014.0176] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael A. Kozminski
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - David J. Kozminski
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - William W. Roberts
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Gary J. Faerber
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - J. Stuart Wolf
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
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Rossi AP, Vella JP. Hypertension, living kidney donors, and transplantation: where are we today? Adv Chronic Kidney Dis 2015; 22:154-64. [PMID: 25704353 DOI: 10.1053/j.ackd.2015.01.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 01/05/2015] [Indexed: 02/08/2023]
Abstract
Hypertension is a prevalent problem in kidney transplant recipients that is known to be a "traditional" risk factor for atherosclerotic cardiovascular disease leading to premature allograft failure and death. Donor, peritransplant, and recipient factors affect hypertension risk. Blood pressure control after transplantation is inversely associated with glomerular filtration rate (GFR). Calcineurin inhibitors, the most commonly used class of immunosuppressives, cause endothelial dysfunction, increase vascular tone, and sodium retention via the renin-angiotensin-aldosterone system resulting in systemic hypertension. Steroid withdrawal seems to have little impact on blood pressure control. Newer agents like belatacept appear to be associated with less hypertension. Transplant renal artery stenosis is an important, potentially treatable cause of hypertension. Dihydropyridine calcium channel blockers mitigate calcineurin inhibitor nephrotoxicity and may be associated with improved estimated GFR. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are not recommended in the first 3 to 6 months given their effects on reduced estimated GFR, anemia, and hyperkalemia. The use of ß-blockers may be associated with improved patient survival, even for patients without cardiovascular disease. Living donation may increase blood pressure by 5 mm Hg or more. Some transplant centers accept Caucasian living donors with well-controlled hypertension on a single agent if they agree to close follow-up.
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Park HM, Choi CJ, Kim JH, Kim JK, Kim BJ, Seo JY, Jeong YS, Kim JK, Kim SG. Page kidney after botulinum toxin injection during chiropractic care. Yeungnam Univ J Med 2015. [DOI: 10.12701/yujm.2015.32.2.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Han Min Park
- Department of Internal Medicine & Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Chung Jo Choi
- Department of Internal Medicine & Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jin Hee Kim
- Department of Internal Medicine & Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ja Kyung Kim
- Department of Internal Medicine & Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Bum Jun Kim
- Department of Internal Medicine & Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jae Yong Seo
- Department of Internal Medicine & Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Yong Seol Jeong
- Department of Internal Medicine & Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jwa-Kyung Kim
- Department of Internal Medicine & Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sung Gyun Kim
- Department of Internal Medicine & Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Korea
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Kumar S, Jayant K, AS S, Singh SK, Agrawal S. Page kidney secondary to large splenic artery aneurysm bleeding and its management by angioembolization. Nephrourol Mon 2014; 6:e17144. [PMID: 25032140 PMCID: PMC4090662 DOI: 10.5812/numonthly.17144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 02/07/2014] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The Page kidney is a rare phenomenon that refers to hypertension resulting from any external compression of a kidney by a hematoma, tumor, lymphocele, or urinoma. The activation of the renin-angiotensin-aldosterone system is believed to be the main mechanism responsible for development of resistant hypertension in Page kidney. CASE PRESENTATION We reported a patient with chronic pancreatitis who presented with hypotension due to splenic artery aneurysmal bleed; following the resuscitation, accelerated hypertension secondary to Page kidney caused by perinephric hematoma presented. Early diagnosis by contrast-enhanced computed tomography of the abdomen and renal angiogram was followed by therapeutic angioembolization. However, ultrasound guided aspiration was not done because of denial by the patient for further treatment. Follow-up showed normalization of blood pressure and resolution of hematoma on subsequent abdomen ultrasound evaluation. DISCUSSION Splenic artery aneurysm is a very uncommon cause of Page kidney and to our knowledge, it was the first case of its kind ever reported in the literature.
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Affiliation(s)
- Santosh Kumar
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kumar Jayant
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sriharsha AS
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sharwan Kumar Singh
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Swati Agrawal
- Department of Obstetrics and Gynecology, Medical College Udaipur, Rajasthan, India
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Traumatic page kidney induced hypertension in critical care: immediately resolved or long-term resistant problem. Case Rep Crit Care 2013; 2013:201424. [PMID: 24829818 PMCID: PMC4010009 DOI: 10.1155/2013/201424] [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: 05/19/2013] [Accepted: 06/28/2013] [Indexed: 11/18/2022] Open
Abstract
Page kidney is a well-known phenomenon causing hypertension, due to compression of renal parenchyma by a subcapsular hematoma, of either traumatic or non-traumatic origin. The main therapeutic approach is based on surgical approach (nephrectomy or hematoma evacuation) and antihypertensive treatment. In this paper we present a post-traumatic case of Page Kidney in a Critical Care unit. We discuss different therapeutical opportunities to extremely elevated systemic blood pressure resistant to traditional drug therapy.
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Abstract
Page kidney refers to the development of secondary hypertension due to compression of the kidney by an external source, most commonly a subcapsular hematoma. Compression of the renal parenchyma results in hypoperfusion and microvascular ischemia leading to activation of the renin-angiotensin system and elevation of blood pressure. Until the last decade, Page kidney was primarily diagnosed in young men with unexplained hypertension and a history of sports-related trauma and imaging studies demonstrating a subcapsular hematoma. Treatment varies from conservative, medical management to a nephrectomy, depending on how the patient’s blood pressure responds to treatment.
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Affiliation(s)
- Kim Michael
- University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Ellie Miller
- University of Nebraska Medical Center, Omaha, NE, USA
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Kelly YP, Eustace JA. Perinephric haematoma causing refractory hypertension in a 17-year-old male. CASE REPORTS IN NEPHROLOGY AND UROLOGY 2012. [PMID: 23197967 PMCID: PMC3482078 DOI: 10.1159/000342241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
New-onset arterial hypertension is a well-recognised complication of kidney trauma. Cases have been described in young healthy athletes with hypertension arising years after sports-related trauma. The pathophysiology of this disease is thought to arise from intrarenal arterial stenosis resulting from rapid deceleration during the initial injury. This leads to arterial obstruction and ischaemia with increased secretion of renin, eventually leading to elevated blood pressure. Though hypertension in these cases is generally gradual in onset and long-standing, it can also rise acutely, leading to malignant hypertension. We present the case of a 17-year-old male who presented with refractory hypertension following blunt trauma to his left kidney during a recent sporting injury. This is followed by a discussion of the relevant literature in this area to date, highlighting the key challenges involved in the management of these patients.
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Affiliation(s)
- Y P Kelly
- Department of Nephrology, Cork University Hospital, Cork, Ireland
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Sliker CW, Steenburg SD, Archer-Arroyo K. Emergency radiology eponyms: part 2--Naclerio's V sign to Fournier gangrene. Emerg Radiol 2012; 20:185-95. [PMID: 23065070 DOI: 10.1007/s10140-012-1082-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 10/04/2012] [Indexed: 10/27/2022]
Abstract
An eponym is a name based on the name of a person, frequently as a means to honor him/her, and it can be used to concisely communicate or summarize a complex abnormality or injury. However, inappropriate use of an eponym may lead to potentially dangerous miscommunication. Moreover, an eponym may honor the incorrect person or a person who falls into disrepute. Despite their limitations, eponyms are still widespread in medicine. Many commonly used eponyms applied to extremity fractures should be familiar to most emergency radiologists and have been previously reported. Yet, a number of non-extremity eponyms can be encountered in an emergency radiology practice as well. This other group of eponyms encompasses a spectrum of traumatic and nontraumatic pathology. In this second part of a two-part series, the authors discuss a number of non-extremity emergency radiology eponyms, including relevant clinical and imaging features, as well biographical information of the eponyms' namesakes.
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Affiliation(s)
- Clint W Sliker
- Diagnostic Imaging Department, University of Maryland Medical Center, 22 S. Greene Street, Baltimore, MD 21201, USA.
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Smyth A, Collins CS, Thorsteinsdottir B, Madsen BE, Oliveira GHM, Kane G, Garovic VD. Page kidney: etiology, renal function outcomes and risk for future hypertension. J Clin Hypertens (Greenwich) 2012; 14:216-21. [PMID: 22458742 DOI: 10.1111/j.1751-7176.2012.00601.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The initial description of Page kidney, a form of renin-mediated hypertension, included athletes with renal subcapsular hematoma after flank trauma. Subsequently, nontraumatic etiologies were identified. In this study, the authors compare traumatic and nontraumatic causes of Page kidney. All cases with hypertension attributable to renal hematoma at our institution from 1960 to 2010 were reviewed. Twenty-six patients (9 trauma, 17 nontrauma), with a mean age of 36.7 years, were included. Trauma patients were younger (P<.001), had lower systolic blood pressures (P=.011), and higher baseline estimated glomerular filtration rate (eGFR), (P=.027) at presentation. No differences in presenting features, imaging, urinalysis, or pathology are noted. Nontrauma cases required more antihypertensive medications (P=.001) and had higher nephrectomy rates. eGFR improved in all, but more in, trauma cases (P=.05). Through the analysis of 26 cases of Page kidney, two distinct groups were identified. Trauma patients tended to be younger, male, have less renal impairment and lower systolic blood pressure. Nontrauma patients required more antihypertensive medications and had a higher nephrectomy rate. New-onset hypertension occurred independent of etiology, calling for close surveillance of blood pressures.
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Affiliation(s)
- Andrew Smyth
- Department of Nephrology, Galway University Hospitals, Galway, Ireland
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Rho M. Quiz page March 2012: postpartum hypertension. Am J Kidney Dis 2012; 59:A27-9. [PMID: 22340911 DOI: 10.1053/j.ajkd.2011.08.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 08/18/2011] [Indexed: 11/11/2022]
Affiliation(s)
- Mira Rho
- Section of Nephrology, Department of Medicine, Saint Mary's Hospital, Waterbury, and Yale University School of Medicine, New Haven, CT
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Pimenta E, Gordon RD, Daunt N, Slater G, Stowasser M. Hyperreninemic hypertension following presumed abdominal trauma. Nat Rev Nephrol 2011; 7:730-4. [DOI: 10.1038/nrneph.2011.127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Butt FK, Seawright AH, Kokko KE, Hawxby AM. An unusual presentation of a Page kidney 24 days after transplantation: case report. Transplant Proc 2011; 42:4291-4. [PMID: 21168685 DOI: 10.1016/j.transproceed.2010.09.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Accepted: 09/03/2010] [Indexed: 02/08/2023]
Abstract
The Page kidney phenomenon is a well recognized entity where an extrinsically compressed kidney results in hypertension and loss of function. This compression is usually caused by a subcapsular hematoma secondary to blunt abdominal trauma or an invasive procedure such as a renal biopsy. We describe an unusual case involving the spontaneous development of a Page kidney 24 days after renal transplantation without any history of preceding trauma. The subcapsular hematoma was detected by a computerized tomographic scan performed as part of the work-up for acute allograft dysfunction. Prompt recognition and early intervention are essential if renal function is to be restored before irreversible damage occurs.
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Affiliation(s)
- F K Butt
- Department of Surgery, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA.
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Burney B, Oliva R, Zorn KC, Bakris G. Hypertension following kidney injury. J Clin Hypertens (Greenwich) 2011; 12:727-30. [PMID: 20883234 DOI: 10.1111/j.1751-7176.2010.00324.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Basil Burney
- Department of Medicine, Hypertension Diseases Unit, Section of Endocrinology, Diabetes, Metabolism and Hypertension, University of Chicago Medical Center, Chicago, IL 60637, USA
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Vo NJ, Hanevold CD, Edwards R, Hoffer FA, Koyle MA. Recurrent Page kidney in a child with a congenital solitary kidney requiring capsular artery embolization. Pediatr Radiol 2010; 40:1837-40. [PMID: 20333510 DOI: 10.1007/s00247-010-1630-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 02/06/2010] [Accepted: 02/26/2010] [Indexed: 11/30/2022]
Abstract
We report an unusual case of a child with a congenital solitary functional kidney complicated by a sports-related posttraumatic Page kidney. The child developed severe hypertension and renal insufficiency requiring percutaneous intervention to preserve renal function. The literature is sparse with no definitive guidelines for the treatment of Page kidney. Following the initial unsuccessful treatment with percutaneous drainage and sclerotherapy procedures, the child ultimately required catheter-directed particle embolization of the capsular arteries to resolve a recurrent subscapsular hematoma definitively. This was successful in preserving renal function and stabilization of the clinical manifestations of the Page kidney.
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Affiliation(s)
- Nghia-Jack Vo
- Department of Radiology, Section of Pediatric Interventional Radiology, Pediatric Radiology, and Vascular Interventional Radiology (M/S R-5417), Seattle Children's Hospital and University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
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