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 d… Show more
“…There is no definitive consensus on the treatment of APK. However, large subcapsular haematomas require an aggressive approach to preserve as much kidney function as possible and prevent long-term complications [ 8 ]. Although haematomas or collections that cause APK can be drained percutaneously, surgical capsulotomy is mandatory in cases of uncontrolled pain, signs of arterial ischaemia or rapidly growing haematomas due to active bleeding [ 4 , 7 , 9 ].…”
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 4 kidney transplant recipients where external compression of the graft was caused by subcapsular hematomas. All patients were treated with surgical drainage, after which 2 cases recovered baseline kidney function, 1 developed advanced chronic kidney disease, and 1 remained dialysis-dependent. To our knowledge, the present series is the largest to describe APK in kidney allografts after percutaneous angioplasty.
“…There is no definitive consensus on the treatment of APK. However, large subcapsular haematomas require an aggressive approach to preserve as much kidney function as possible and prevent long-term complications [ 8 ]. Although haematomas or collections that cause APK can be drained percutaneously, surgical capsulotomy is mandatory in cases of uncontrolled pain, signs of arterial ischaemia or rapidly growing haematomas due to active bleeding [ 4 , 7 , 9 ].…”
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 4 kidney transplant recipients where external compression of the graft was caused by subcapsular hematomas. All patients were treated with surgical drainage, after which 2 cases recovered baseline kidney function, 1 developed advanced chronic kidney disease, and 1 remained dialysis-dependent. To our knowledge, the present series is the largest to describe APK in kidney allografts after percutaneous angioplasty.
“…The working diagnosis was that of Page kidney producing the initial increase in serum creatinine from a baseline of 1.31 mg/dL to 1.86 mg/dl on admission[ 1 3 ] [ Figure 1 ]. Serum creatinine, which was stable for the previous 2 years was 1.31 mg/dL 4 weeks before the kidney biopsy.…”
Section: Discussionmentioning
confidence: 99%
“…On admission, the serum creatinine had significantly increased to 1.86 mg/dL, consistent with acute kidney injury associated with Page kidney. [ 1 2 3 ] He subsequently developed reversible contrast-induced nephropathy following the double exposure to iodinated contrast on admission day– first, from the contrast-enhanced CT examination, and second, during the coil embolization procedure[ 4 ] [ Figure 1 ].…”
Section: Discussionmentioning
confidence: 99%
“…[ 2 ] More recently, this syndrome has also been described following intrarenal mechanisms such as sub-capsular and renal parenchymal hematomas, renal cysts, and renal tumors. [ 2 3 ] We describe Page kidney complicating ultrasound-guided right native kidney biopsy in a 73-year-old Caucasian male after withholding Apixaban, 3 days before the renal biopsy procedure and had restarted the Apixaban 3 days post-procedure. The evidence-base to guide peri-procedural management of NOACs is inadequate.…”
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.
“…The sonographic appearance of a subcapsular renal hematoma is usually a crescent-shaped or ellipsoid hyper-, iso- or hypoechoic lesion located around the kidney in the subcapsular space. Hematomas can appear heterogenous and hyperechogenic in the acute phase, becoming more hypoechoic or cystic over time [8, 9]. Technically, the kidneys are usually well identified using a standard curvilinear probe.…”
Background
Extracorporeal shock wave lithotripsy is widely used to treat symptomatic nephrolithiasis. Complications of this procedure can occur and point-of-care ultrasound can help to diagnose and manage some of these cases.
Case presentation
A 61-year-old man was admitted to the hospital with intense right lumbar pain 24 h after being submitted to a extracorporeal shock wave lithotripsy. Bedside ultrasound showed a hyperechoic subcapsular lesion along the right kidney. This finding, along with the clinical examination, suggested the diagnosis of subcapsular renal hematoma. The patient was managed conservatively with clinical and ultrasound reassessments.
Conclusions
This case shows the use of bedside ultrasound to diagnose a subcapsular renal hematoma as a complication of extracorporeal shock wave lithotripsy. However, the sensitivity is low and other image methods can be necessary to make the diagnosis.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.