Page Kidney: An Unusual Complication of a Renal Transplant Biopsy

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.

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

“…Compression of the parenchyma can compromise the intra renal blood flow which activates Renin-Angiotensin-Aldosterone System (RAAS) leading to systemic hypertension. In most cases, Page kidney compression causing hypertension is extra capsular in origin as it was in our patient [6] . Post procedural bleeding following renal biopsy is one of the causes for Page kidney [7] .…”

“…Hypertension is the main clinical presentation of Page kidney with refractory hypertension developing immediately after causative event [9] . It may also present with acute pain over the biopsy site, reduced urine output (mostly in single kidney or diseased contralateral kidney) and features of disseminated intravascular coagulation [6] . Ultrasound doppler may reveal reduction of blood flow in the renal artery and parenchyma of the affected kidney.…”

Page phenomenon in a transplanted kidney: is it salvageable?

“…However, most of these cases are due to iatrogenic causes, mainly biopsies, and, less frequently, trauma 4. Surgical decompression has been found to be the intervention of choice and has resolved it successfully in about 80% of the cases reported in the literature 5 15–24. However, even with surgical evacuation, the results could be unfavourable with still a high risk of losing the graft.…”

<p>Urinary Urgency: A Symptom In Need Of A Cure</p>

“…Therefore, a more flexible approach was desired to better balance efficacy and safety and a switch to fesoterodine 4 mg daily was suggested with instructions to increase to 8 mg daily if required, since fesoterodine 8 mg has proven superiority compared to 4 mg in reducing UUI episodes in a head-to-head comparison in OAB patients 7. Fesoterodine has also been demonstrated to have consistent efficacy on urgency in several randomized clinical trials 7–11. One month later, her urgency had improved after dose escalation to 8 mg, but her dry mouth symptoms were slightly worse.…”