Page Kidney: An Unusual Cause of Hypertension

Abstract

A case of classical Page kidney with emphasis on radiographic findings is presented. Onset of hypertension following trauma associated with angiographic findings of attenuation, splaying and stretching of the intrarenal vessels on the arterial phase with a definite delay in transit time through the parenchyma and a non-homogeneous nephrogram should make the diagnosis of Page kidney or constricting subcapsular mass the most logical consideration.

Renal Parenchymal Compression Producing Hypertension (Page Kidney)

“…The hypertensive effect of renal compression was first described by Page in 1939, when he produced hypertension in animals subjected to cellophane induced perinephritis. Since his description, thirty patients have been documented as having hypertension secondary to renal compression (Conrad er a/, 1976;Grant er al, 1971;Grim er al, 1975;Hellenbusch er al, 1970;Marshall and Castellino, 1971;Massumi er 01, 1969;Scott et al, 1976;Sos et al, 1973). Most cases have been due t o chronic subcapsular haematomas.…”

“…The parenchymal outline is flattened and the collecting system and intrarenal branches of the renal artery are stretched around an avascular mass. Prolonged circulation time, an inhomogeneous nephrogram due to focal ischaemia, and decreased arborization are also described (Scott et al, 1976;Grim et al, 1975). When these appearances are seen in a young hypertensive patient, the possibility of organising haematoma is a primary consideration.…”

Page Kidney: A Curable Form of Arterial Hypertension

“…Usual ly, the hypertensive patient is young and with a previous history of trauma. IVP shows a definite delay in transit time with distortion of the calyceal configuration [6]. The renal arteriogram demonstrates no renal artery nar rowing (Goldblatt kidney) but attenuation and stretching of the intrarenal vessels.…”

“…In spite of a history of renal trauma, only 41% of these patients had gross hematuria and 4% microscopic hema- turia; 55% had neither gross nor microscopic hematuria [5].The time lag between the trauma and the diagnosis of hypertension varied widely from 24 h to 12 years. How ever, as the development of a Page kidney still remains a rare complication, it is likely that only the hematomas who cause subcapsular fibrosis and parenchymal com pression are prone to produce hypertension [6]. This may contribute to explaining the low incidence of sec ondary hypertension in patients with perirenal hemato mas following percutaneous renal biopsy.…”

Long Renal Arteries

“…A human counterpart of this identifiable form of hypertension caused by post-traumatic perinephric hematoma and resulting fibrosis, the "Page" kidney, has also been shown to be renin-dependent and responsive to removal of the damaged kidney. 6 Reports of many reninsecreting tumors of a wide variety of causes have appeared since the initial one, 7 often with resolution of the hypertension on removal of the affected kidney. Another uncommon renal abnormality associated with hypertension and hypersecretion of renin is the Ask-Upmark kidney, 8 thought to result from partial amputation of the kidney as the result of infection, trauma, or of idiopathic origin.…”