- Email: [email protected]
Page kidney
nephrology image
http://www.kidney-international.org & 2007 International Society of Nephrology
Kidney International (2007) 72, 1562; doi:10.1038/sj.ki.5002580
Page kidney TV Patel1 and N Goes2 1
Renal Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA and 2Renal Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA Correspondence: TV Patel, Renal Division, Department of Medicine, Brigham and Women’s Hospital, MRB-4, 75 Francis Street, Boston, Massachusetts 02115, USA. E-mail: [email protected]
Figure 1 | Ultrasound of the allograft (a) sagittal view and (b) coronal view demonstrating subcapsular hematoma (arrows).
Figure 2 | Computed tomography scan (axial view) showing the hematoma (arrows).
A 69-year-old male patient with diabetic nephropathy, who received a renal allograft 7 years ago, underwent ultrasoundguided allograft biopsy for renal insufficiency (1.11.5 mg dl 1). His baseline blood pressure was 132/80 mm Hg. The coagulation parameters were normal. The procedure was uneventful. On the following day, he developed oliguria without hematuria. Blood pressure was 180/100 mm Hg, serum creatinine rose to 2.8 mg dl 1, and the hematocrit dropped from 34.9 to 30.5%. He underwent urgent ultrasound of the allograft (Figure 1a and 1b) and subsequently computed tomography scan (Figure 2), which revealed a contained subcapsular renal hematoma measuring 9 2 cm. There was no evidence of hydronephrosis or blood clot in the ureter. A diagnosis of ‘Page kidney’ was made. The hematoma was evacuated surgically after failed conservative management. The patient’s urine output, blood pressure (142/84 mm Hg), and serum creatinine (1.6 mg dl 1) improved 48 h after surgery.
1562
Page kidney named after Irwin Page refers to the occurrence of hypertension secondary to external renal compression. In Page’s model, cellophane wrapping of the kidney caused constrictive perinephritis with resulting hypertension. Any cause leading to compression of the kidney, such as perinephric or subcapsular hematomata (and rarely cysts and tumors), may cause the Page kidney. The hypoperfusion from renal compression is believed to activate the renin–angiotensin–aldosterone system causing an increase in retention of salt and water and resulting hypertension. With solitary kidneys (such as renal transplant), renal insufficiency has also been reported. Conservative treatment with antihypertensive agents and fluid control is generally sufficient. In rare cases, surgical evacuation of the hematoma is warranted.
Kidney International (2007) 72, 1562
http://www.kidney-international.org & 2007 International Society of Nephrology
Kidney International (2007) 72, 1562; doi:10.1038/sj.ki.5002580
Page kidney TV Patel1 and N Goes2 1
Renal Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA and 2Renal Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA Correspondence: TV Patel, Renal Division, Department of Medicine, Brigham and Women’s Hospital, MRB-4, 75 Francis Street, Boston, Massachusetts 02115, USA. E-mail: [email protected]
Figure 1 | Ultrasound of the allograft (a) sagittal view and (b) coronal view demonstrating subcapsular hematoma (arrows).
Figure 2 | Computed tomography scan (axial view) showing the hematoma (arrows).
A 69-year-old male patient with diabetic nephropathy, who received a renal allograft 7 years ago, underwent ultrasoundguided allograft biopsy for renal insufficiency (1.11.5 mg dl 1). His baseline blood pressure was 132/80 mm Hg. The coagulation parameters were normal. The procedure was uneventful. On the following day, he developed oliguria without hematuria. Blood pressure was 180/100 mm Hg, serum creatinine rose to 2.8 mg dl 1, and the hematocrit dropped from 34.9 to 30.5%. He underwent urgent ultrasound of the allograft (Figure 1a and 1b) and subsequently computed tomography scan (Figure 2), which revealed a contained subcapsular renal hematoma measuring 9 2 cm. There was no evidence of hydronephrosis or blood clot in the ureter. A diagnosis of ‘Page kidney’ was made. The hematoma was evacuated surgically after failed conservative management. The patient’s urine output, blood pressure (142/84 mm Hg), and serum creatinine (1.6 mg dl 1) improved 48 h after surgery.
1562
Page kidney named after Irwin Page refers to the occurrence of hypertension secondary to external renal compression. In Page’s model, cellophane wrapping of the kidney caused constrictive perinephritis with resulting hypertension. Any cause leading to compression of the kidney, such as perinephric or subcapsular hematomata (and rarely cysts and tumors), may cause the Page kidney. The hypoperfusion from renal compression is believed to activate the renin–angiotensin–aldosterone system causing an increase in retention of salt and water and resulting hypertension. With solitary kidneys (such as renal transplant), renal insufficiency has also been reported. Conservative treatment with antihypertensive agents and fluid control is generally sufficient. In rare cases, surgical evacuation of the hematoma is warranted.
Kidney International (2007) 72, 1562