Traumatic Page Kidney Induced Hypertension in Critical Care: Immediately Resolved or Long-Term Resistant Problem

Abstract

Page kidney is a well-known phenomenon causing hypertension, due to compression of renal parenchyma by a subcapsular hematoma, of either traumatic or non-traumatic origin. The main therapeutic approach is based on surgical approach (nephrectomy or hematoma evacuation) and antihypertensive treatment. In this paper we present a post-traumatic case of Page Kidney in a Critical Care unit. We discuss different therapeutical opportunities to extremely elevated systemic blood pressure resistant to traditional drug therapy.

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

“…Compression by the renal pseudocyst, however, has not yet been described as causing a Page kidney (Page induced hypertension in canine kidneys by wrapping them with cellophane) 13. The designation refers to hypertension caused by external renal compression by a haematoma, tumour, lymphocele or urinoma 13 14.…”

“…The designation refers to hypertension caused by external renal compression by a haematoma, tumour, lymphocele or urinoma 13 14. Page kidney typically occurs due to compression by a subcapsular haematoma.…”

“…Uncommon instances associated with warfarin therapy, polyarteritis nodosa and extracorporeal shockwave lithotripsy have also been described. Consequently, there is renal hypoperfusion; although the main renal artery is unaffected 13 15. This microvascular ischaemia causes a surge in renin levels, which switches on the renin–angiotensin–aldosterone cascade of hypertension.…”

Page Kidney: A Case of Acute or Chronic Renal Failure & Refractory HTN Presenting after Renal Biopsy

“…Acute onset of flank/abdominal pain, tenderness, as well as an acute drop in hemoglobin and hematocrit after a potential injury should all raise concern for retroperitoneal bleed [4]. Many cases of Page Kidney can be successfully managed by controlling the associated hypertensive disorder [5]. A CT scan without contrast should be ordered immediately followed by prompt surgical evaluation.…”

Bilateral nontraumatic recurrent Page kidney

“…Page kidney is the rare condition in which there is external compression of the kidneys due to a subcapsular hematoma, tumor, lymphocele, or urinoma, which leads to hypertension because of the activation of the renin-angiotensin-aldosterone system [1] , [2] . It has been reported in all age segments and patients in association with mostly subcapsular or perinephric hematoma due to traumatic or iatrogenic interventions including surgical complications such as ureteral surgery and postrenal biopsy [2] .…”