Exploration of Hypertension Following Traumatic Renal Hematoma Formation and Page Kidney Discussion.

Page kidney is defined as a rare cause of secondary hypertension due to a subcapsular hematoma externally compressing the kidney resulting in the activation of the renin-angiotensin-aldosterone system (RAAS). This phenomenon consists of numerous etiologies including acute or chronic traumatic or non-traumatic events. In this case, we report on an acute unilateral hematoma following blunt renal trauma as the result of a fall from standing height treated with tissue plasminogen activator (tPA) infusion and image-guided drainage. Qualities within this case and how they are paralleled in the diagnosis of a Page kidney are explored. A brief review of current etiologies and management plans per the literature review will also be discussed.

A fatal misdiagnosis of page kidney - case report.

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.

Case report: Page kidney with multiple serosal effusions caused by bilateral spontaneous renal subcapsular hemorrhage.

Page kidney is caused by the perirenal or subcapsular accumulation of blood or fluid pressing on the renal parenchyma and is a rare cause of secondary hypertension. In this study, we report a case of Page caused by bilateral spontaneous subcapsular renal hematoma, the main manifestations of which were secondary hypertension, multiple serous effusions, and renal insufficiency. After admission, drug blood pressure control was ineffective. After bilateral perirenal effusion puncture and drainage were performed to relieve bilateral perirenal compression, blood pressure gradually dropped to normal, multi-serous cavity effusion (pericardial, thoracic, and abdominal effusion) gradually disappeared, and kidney function returned to normal. Secondary hypertension caused by Page kidney can be treated. When Page kidney is complicated with multiple serous effusions, the effect of antihypertensive drugs alone is poor, and early perineal puncture drainage can achieve better clinical efficacy.

Reversed diastolic intrarenal flow in page kidney following renal biopsy.

Page's kidney is a condition that occurs due to external renal compression, usually caused by a subcapsular haematoma, generating a renal compartmental syndrome with parenchymal damage and renal perfusion alteration. Classically associated with renal trauma, Page's kidney can also arise after invasive renal procedures, such as renal biopsies or percutaneous nephrostomies. Clinically, it can trigger hypertension due to activation of the renin-angiotensin system induced by hypoperfusion secondary to renal parenchymal compression and can also present with varying degrees of renal function impairment. Furthermore, severe acute renal failure may be found particularly in patients with solitary kidneys or renal transplants. We present two cases of Page's kidney after renal biopsy and their PoCUS ultrasound findings. We would like to highlight the reversed diastolic flow on Doppler ultrasound in this entity, a pattern we have found in all two cases.

A Rare Case of Page Kidney in a Young Man with Flank Pain.

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.

Hypertensive Emergency in a Spontaneous Page Kidney.

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.

Renal tamponade in a patient with hydronephrosis-related Page kidney.

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.

Bilateral Page kidney in a postpartum female: a case report.

Page kidney results from external compression of the kidney by a subcapsular hematoma and is one of the rare but treatable causes of secondary hypertension. The majority are traumatic or iatrogenic and often unilateral. Spontaneous bilateral Page kidney is rare. Case Presentation: A 35-year P1 with gestational hypertension presented with a persistent postpartum elevation of blood pressure (BP). Imaging studies revealed bilateral renal subcapsular hematoma (left>right). She was managed with an angiotensin receptor blocker initially and ultrasound-guided percutaneous drainage of the collection for the optimal control of elevated BP. Clinical Discussion: Ultrasonography and computed tomography of the kidneys are the most frequently used for diagnosing a Page kidney. Medical management with antihypertensive and regular follow-ups form the first line of treatment in Page kidneys. Percutaneous drainage, surgical decortication, laparoscopic intervention, and nephrectomy are necessary in cases of organized late hematomas. Conclusion: Spontaneous bilateral Page kidney is a rare but potentially treatable and curable form of hypertension. Percutaneous drainage is an effective method to drain the hematoma and control elevated BP.

A Rare Case of Page Kidney With Superimposed Infection.

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.

A Rare Case of Intravenously Managed Hypertensive Emergency Arising from a Perirenal Hematoma Subsequent to a Native Kidney Biopsy.

Page kidney is a pathologic and rare occurrence caused by a compression of renal parenchyma leading to hypertension. When infiltrated or engulfed by extrinsic matter, the subcapsular region surrounding the renal tissue may cause blanket compression, leading to the activation of the renin-angiotensin-aldosterone system secondary to renal hypoperfusion. While most cases of Page kidney are secondary to blunt trauma to the costovertebral angle, herein we present a case of Page kidney due to renal parenchymal core needle biopsy. The rarity of our case is not due to the cause of such an incidence but because our case resulted in a hypertensive emergency treated with dual intravenous infusions.

Surgically managed acute Page kidney following renal biopsy-A case report.

INTRODUCTION AND IMPORTANCE: Renal biopsy performed in native or transplanted kidney is considered a safe procedure. However, as it is an invasive procedure bleeding related complications do occur. Bleeding complications such as macroscopic hematuria, renal hematoma, blood transfusion, and rarely nephrectomy and death have been reported in various studies. Acute Page kidney (APK) is a rare complication of post renal biopsy bleeding. CASE PRESENTATION: In this case report we present a case history of a 46-year-old patient complicated with APK, following a native kidney biopsy. Early surgical exploration and evacuation of large hematoma resulted in a favorable outcome. CLINICAL DISCUSSION: APK results from external compression of kidney and compression of the parenchyma can compromise the intra renal blood flow and cause renal impairment, activation of Renin-Angiotensin-Aldosterone System (RAAS) leads to systemic hypertension. CONCLUSION: Awareness, early recognition and timely intervention in APK, in a post renal biopsy bleeding is necessary to prevent poorer outcomes, especially progressively large hematoma is present and response to medical management inadequate.

Page kidney following spontaneous subcapsular hematoma immediately after kidney transplantation: a case report.

BACKGROUND: Page kidney (PK) is the occurrence of kidney hypoperfusion and ischemia due to pressure on the kidney by a subcapsular hematoma (SH), a mass, or fluid collection. SH after renal transplantation may result in kidney ischemia and graft loss. CASE PRESENTATION: We present a rare case of early spontaneous SH in an allograft kidney that led to a decrease in renal function. A 56-year-old male patient underwent deceased donor kidney transplantation. After declamping, appropriate renal perfusion and immediate diuresis were observed, with no evidence of SH. However, his urinary output abruptly decreased 6 h postoperatively. Abdominal ultrasonography showed 28 mm deep SH on transplant and the resistive index (RI) increased to 0.98-1 and diastolic flow reversal was observed. Surgical interventions were performed 2 days after transplantation, following a further decrease in urinary output. Serum creatinine decreased to 2.2 mg/dL, urinary output increased to an average of 200 cc per hour and the RI value was decreased to 0.7 on POD 7. CONCLUSION: In patients with abrupt decreased renal function after transplantation, SH should be suspected and the presence of PK should be determined using Doppler USG. In these cases, surgical intervention may avoid allograft dysfunction.

Page kidney after pediatric kidney transplantation: a case report. / Riñón de Page tras trasplante renal pediátrico: informe de un caso.

INTRODUCTION: Page kidney (PK) is a rare condition caused by parenchymal compression due to a subcapsular hematoma. Irreversible damage of the graft may occur if this condition is not recognized and treated properly. CLINICAL CASE: We describe the case of a 16-year-old man with chronic renal failure secondary to corticosteroid-resistant nephrotic syndrome (CRNS) caused by NPHS2 mutations. The patient underwent a 5th fifth living-related KT. The graft was placed intraperitoneally and reperfused well without complications. On the 4th postoperative day his labs demonstrated raising creatinine associated with refractory hypertension, gross hematuria and anemia. Urgent ultrasound revealed a subcapsular hematoma with signs of parenchymal compression. PK phenomenon was suspected and urgent surgical intervention decided. COMMENTS: PK is a rare but an emergence potentially treatable and reversible complication after pediatric KT. Early diagnosis based on clinical suspicion and suggestive imaging are the key points for a favorable outcome.

INTRODUCCION: El riñón de Page (RP) es una enfermedad rara provocada por compresión parenquimatosa debido a un hematoma subcapsular. El injerto puede sufrir daños irreversibles si la enfermedad no se reconoce y se trata de forma adecuada. CASO CLINICO: Describimos el caso de un varón de 16 años con fallo renal crónico secundario a síndrome nefrótico corticorresistente (SNCR) provocado por mutaciones del gen NPHS2. El paciente se somete a un quinto TR de donante vivo. El injerto se coloca en posición intraperitoneal, con una adecuada reperfusión, sin complicaciones. Al cuarto día postoperatorio, sus análisis revelan una subida de la creatinina asociada a hipertensión refractaria, hematuria macroscópica y anemia. La ecografía de urgencia revela hematoma subcapsular con signos de compresión parenquimatosa. Se sospecha RP y se decide intervención quirúrgica de urgencia. COMENTARIOS: El RP es una complicación rara y urgente, aunque a su vez tratable y reversible, tras TR pediátrico. El diagnóstico precoz basado en la sospecha clínica y las imágenes son claves a la hora de conseguir un resultado favorable.

Riñón de Page tras trasplante renal pediátrico: informe de un caso / Page kidney after pediatric kidney transplantation: a case report

Introducción: El riñón de Page (RP) es una enfermedad rara provocada por compresión parenquimatosa debido a un hematoma subcapsular. El injerto puede sufrir daños irreversibles si la enfermedad no se reconoce y se trata de forma adecuada.Caso clínico: Describimos el caso de un varón de 16 años con fallo renal crónico secundario a síndrome nefrótico corticorresistente (SNCR) provocado por mutaciones del gen NPHS2. El paciente se somete a un quinto TR de donante vivo. El injerto se coloca en posición intraperitoneal, con una adecuada reperfusión, sin complicaciones. Alcuarto día postoperatorio, sus análisis revelan una subida de la creatininaasociada a hipertensión refractaria, hematuria macroscópica y anemia.La ecografía de urgencia revela hematoma subcapsular con signos de compresión parenquimatosa. Se sospecha RP y se decide intervenciónquirúrgica de urgencia. Comentarios: El RP es una complicación rara y urgente, aunque a su vez tratable y reversible, tras TR pediátrico. El diagnóstico precoz basado en la sospecha clínica y las imágenes son claves a la hora de conseguir un resultado favorable.

Introduction: Page kidney (PK) is a rare condition caused by parenchymal compression due to a subcapsular hematoma. Irreversible damage of the graft may occur if this condition is not recognized and treated properly.Clinical case: We describe the case of a 16-year-old man withchronic renal failure secondary to corticosteroid-resistant nephroticsyndrome (CRNS) caused by NPHS2 mutations. The patient underwent a 5th fifth living-related KT. The graft was placed intraperitoneallyand reperfused well without complications. On the 4 th postoperativeday his labs demonstrated raising creatinine associated with refractoryhypertension, gross hematuria and anemia. Urgent ultrasound revealeda subcapsular hematoma with signs of parenchymal compression. PKphenomenon was suspected and urgent surgical intervention decided.Comments: PK is a rare but an emergence potentially treatableand reversible complication after pediatric KT. Early diagnosis basedon clinical suspicion and suggestive imaging are the key points for afavorable outcome.

Spontaneous Page kidney from ruptured renal angiomyolipoma.

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.

A case report of post-surgical page kidney due to extensive renal hematoma following percutaneous nephrolithotomy.

INTRODUCTION AND IMPORTANCE: Post-surgical Page kidney due to large renal hematoma following percutaneous nephrolithotomy (PCNL) is a rare significant complication that may lead to loss of a kidney. CASE PRESENTATION: A 50-year-old lady underwent elective left side PCNL for a 3 cm renal pelvis stone, and one week later, she presented back with a massive renal hematoma with high blood pressure. CLINICAL DISCUSSION: The ultrasound abdomen and computed tomography diagnosed a page kidney due to massive intrarenal and perirenal hematoma as a complication of PCNL. Angioembolization and percutaneous aspiration were failed, and the antihypertensives also failed to control the blood pressure. Therefore, she underwent a left-side simple nephrectomy and had an uneventful recovery with reversal of normal blood pressure. CONCLUSION: Post-surgical page kidney needs to identify early to facilitate the percutaneous radiological interventions that may preserve the renal parenchyma and avoid further surgeries. Nevertheless, late cases or the failed radiologically intervened cases need open renal exploration and simple nephrectomy, which may be the bailed-out procedure to reverse the consequence of page kidney.

Acute Page kidney after angioplasty in kidney transplant allografts.

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.

Tourette syndrome associated with Page kidney.

BACKGROUND: Page kidney is a rare condition leading to secondary hypertension and encountered most frequently due to traumatic subcapsular hematoma. Here, we present a case of a 15-year-old boy with a history of Tourette syndrome, who had Page kidney hypertension secondary to subcapsular hematoma compression due to his self-injury behavior for many years.

Page kidney: Rare cause of acute kidney injury after complicated renal artery angioplasty.

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.