Abstract: PUB005
Spontaneous Page Phenomenon in a Pelvic Kidney
Session Information
Category: Trainee Case Report
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Ahmad, Yahya Rauf, University of Kentucky, Lexington, Kentucky, United States
- Wilson, William Louis, University of Kentucky, Lexington, Kentucky, United States
- Robinson, Megan M., University of Kentucky, Lexington, Kentucky, United States
- Ayach, Taha, University of Kentucky, Lexington, Kentucky, United States
Introduction
Page kidney or Page phenomenon refers to compression of the renal parenchyma by subcapsular hematoma. Here we report the first case of spontaneous Page phenomenon in a native pelvic kidney.
Case Description
A 64-year old male with a diagnosis of diabetes mellitus, essential hypertension, chronic kidney disease stage 3b, stage 3 obesity with a body mass index of 53, congenital right-sided pelvic kidney, presented to the emergency room with acute-onset, severe, right lower quadrant abdominal pain. Patient denied having any recent trauma and had no urinary or gastrointestinal complaints. He was not on any antiplatelet or anticoagulation medications. CT angiogram of the abdomen and pelvis was performed which demonstrated a subcapsular hematoma around the right pelvic kidney. He had AKI with a peak creatinine of 4.2 mg/dL from a baseline of 2.2 mg/dL. He remained non-oliguric, with gradual improvement of his renal functions and never required renal replacement therapy or any intervention for Page kidney. He presented with markedly elevated blood pressure of 190/110 mmHg and his hospital course was significant for sustained elevated blood pressure requiring addition of four new anti-hypertensive medications by discharge. Subsequent imaging showed marked decrease in the subcapsular hematoma in a week.
Discussion
Page phenomenon is a rare but potentially fatal condition that can result from trauma, tumor, vasculitis, renal cyst rupture, or procedures like kidney biopsy. External compression of renal parenchyma can result in interstitial ischemia, tubulointerstitial nephritis and compression of intrarenal vessels thus activation of renin angiotensin system (RAS), resulting in AKI and hypertension associated with Page kidney. Persistently elevated blood pressure unresponsive to medical therapy or gradually enlarging hematoma with worsening renal functions might require percutaneous drainage, capsulotomy or even nephrectomy. Optimal medical management of Page kidney includes medications targeting the RAS pathway.