Page kidney due to a renal pseudocyst in a setting of pancreatitis

Abstract

SUMMARYPancreatic pseudocysts are notorious for their extension beyond the normal confines of the pancreatic bed due to dissection of the enzymatic pseudocyst fluid along fascial planes. Such collections of pancreatic juice may compress the kidney. Extension of the pseudocyst into the perirenal space is, however, uncommon. We report a case of pseudocyst of pancreas lying in the subcapsular plane of the left kidney with a patent communication with the pancreatic duct ( pancreaticorenal fistula). The compressive effect of the pseudocyst on the kidney compromised intrarenal perfusion as evidenced by a faint nephrogram but a normal renal artery. This led to reninangiotensin-aldosterone mediated hypertension-the Page kidney phenomenon. Extensive literature search revealed our case to be the only one to describe such an occurrence. BACKGROUND

Clinical manifestations, imaging features, and endoscopic management of renal pseudocysts: a case series

“…In our study, all the 8 patients had involvement of the left kidney and none had RP on the right side. The clinical presentation of RP can be varied and has been reported as incidentally detected renal masses, or presenting with abdominal pain or complications such as perirenal abscess, obstructive hydronephrosis, pseudoaneurysm or reninmediated hypertension [8,[15][16][17]. In our study, all the patients with RP presented with abdominal pain and all 3 patients with large RP also had loin pain.…”

“…Renal pseudocysts (RP) occur rarely and have been mentioned in the literature only as case reports [7][8][9][10][11][12][13]. There is paucity of literature on the clinical manifestations and radiological findings in patients with RP.…”

“…The management of pancreatic RP is also debatable. Percutaneous drainage or surgery has been described as a treatment modality in the literature [8][9][10]. With the advent of minimally invasive endoscopic transpapillary as well as transmural drainage, there have been reports of successful treatment of pancreatic pseudocysts at atypical locations [2,6,14].…”

A Rare Cause of Renal Atrophy: Subcapsular Collection Presented as a Huge Perirenal Complex Cyst

“…A hematoma is the most frequent type of renal subcapsular collection and may occur following trauma, anticoagulant therapy, and interventional procedures [1,[4][5][6]. Renal subcapsular pseudocyst may also be encountered as a complication of acute pancreatitis [3]. A urinoma can also be the underlying cause of subcapsular collection particularly in the setting of obstructive uropathy (i.e., ureteral stone, retroperitoneal fibrosis, bladder cancer) complicated by forniceal rupture [7,8].…”

“…Subcapsular collections may induce significant pressure on renal parenchyma due to boundary effect of renal capsule. In the setting of renal vessel compression, one may identify the new onset of increased blood pressure due to activation of the renin-angiotensin system, which is also called as Page kidney [2,3]. However, in the case of long standing compression, the kidney may undergo atrophy and imaging based evaluation could be challenging.…”