Page Kidney: A Secondary Cause of Hypertension

Authors

  • Matthew Agnew University of Toledo
  • Anas Renno University of Toledo Department of Hospital Medicine
  • Asif Mahmood University of Toledo Department of Hospital Medicine

DOI:

https://doi.org/10.46570/utjms.vol8-2020-420

Keywords:

Page kidney, secondary hypertension, hematoma, subcapsular hematoma, subcapsular fluid

Abstract

Page kidney is a rare cause of secondary hypertension in adults that occurs due to extrinsic compression of the kidney due to a subcapsular collection, such as a hematoma or urinoma. Usually these subcapsular formations are a result of trauma to the kidney such as from a biopsy or motor vehicle accident. Here we present a case of a 61-year old African American male who presented to the hospital with worsening shortness of breath for 2 days, a blood pressure of 203/156, and a BNP of 206. He was admitted and treatment was begun for diastolic congestive heart failure and hypertensive emergency. Clinically, he was improving but his systolic blood pressure continued to be in the 150’s despite multiple blood pressure medications. Due to this difficulty in controlling blood pressure and a negative renal ultrasound, an abdominal CT scan with contrast was ordered and revealed a subcapsular fluid collection indenting the lateral margin of the left kidney measuring approximately 7.1 x 5.4 x 2.3 cm that was suggestive of a Page kidney per radiology. Upon further history taking it was found that the patient has had received extracorporeal shock wave lithotripsy for nephrolithiasis in past several months which is a known risk factor for subcapsular hematoma formation. Ultimately it was determined that this subcapsular hematoma was resolving on its own and no intervention was needed other than follow-up as an outpatient. We feel this case is noteworthy for not only being a presentation of a Page kidney, but also demonstrates the importance of considering a secondary cause to hypertension in patients with difficult to control hypertension.

References

PAGE IH. THE PRODUCTION OF PERSISTENT ARTERIAL HYPERTENSION BY CELLOPHANE PERINEPHRITIS. JAMA. 1939;113(23):2046–2048. doi:10.1001/jama.1939.02800480032008

Labanaris AP, Kühn R, Schott GE, Zugor V. Perirenal hematomas induced by extracorporeal shock wave lithotripsy (ESWL). Therapeutic management. ScientificWorldJournal. 2007;7:1563-1566. Published 2007 Sep 17. doi:10.1100/tsw.2007.236

Schnabel, M.J., Gierth, M., Chaussy, C.G. et al. Incidence and risk factors of renal hematoma: a prospective study of 1,300 SWL treatments. Urolithiasis 42, 247–253 (2014). https://doi.org/10.1007/s00240-014-0637-4

Naranjo Muñoz J, Narváez C, Villanego F, Mazuecos MA, Ceballos M. Page kidney as a complication after a shock wave lithotripsy: a case report. CEN Case Rep. 2018;7(2):330-331. doi:10.1007/s13730-018-0361-y

Dopson SJ, Jayakumar S, Velez JC. Page kidney as a rare cause of hypertension: case report and review of the literature. Am J Kidney Dis. 2009 Aug;54(2):334-9. doi: 10.1053/j.ajkd.2008.11.014. Epub 2009 Jan 23. PMID: 19167799.

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Published

2021-03-03

How to Cite

Agnew, M., Renno, A., & Mahmood, A. (2021). Page Kidney: A Secondary Cause of Hypertension. Translation: The University of Toledo Journal of Medical Sciences, 8. https://doi.org/10.46570/utjms.vol8-2020-420

Issue

Section

Case Reports