Abstract: PO1769
Turning the Page on Page Kidney with Dual RAAS Blockade
Session Information
- Hypertension and CVD: New insights
November 04, 2021 | Location: On-Demand, Virtual Only
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention
Authors
- Assante, William J., Westchester Medical Center Health Network, Valhalla, New York, United States
- Griffiths, Jennifer, Westchester Medical Center Health Network, Valhalla, New York, United States
- Kapoor, Aromma, Westchester Medical Center Health Network, Valhalla, New York, United States
Introduction
Page kidney is a rare form of secondary hypertension from activation of the renin-angiotensin-aldosterone (RAAS) axis by compression of renal parenchyma. It can occur with blunt abdominal trauma/procedures, but it can occur spontaneously. Initial treatment is an ACE inhibitor (ACE) or angiotensin receptor blocker (ARB). Surgical intervention is pursued if more conservative measures fail. Procedures carry their own intrinsic risk for morbidity and mortality, particularly in the setting of uncontrolled hypertension. This report details the case of a patient with Page kidney responsive to an unconventional conservative management approach: dual RAAS blockade with ACE + ARB after a lack of response with other agents.
Case Description
The patient is a 55M with a history of end stage renal disease (ESRD) on hemodialysis (HD), atrial fibrillation, and type 2 diabetes mellitus admitted for anemia. The patient was dyspneic and weak with right flank pain. He denied hematemesis, melena, or hematuria. Hemoglobin on admission was 4.7 g/dL with INR of 4.8 (on Coumadin for atrial fibrillation). Vitals were normal except a fever to 38.4 C. A CT scan of the abdomen showed a 16.5cm right retroperitoneal hematoma adjacent to the right kidney with anterior dislocation of the kidney. A CT angiogram showed active extravasation within the hematoma. Coumadin was held and a dose of Vitamin K and two units of blood were given. The patient underwent renal artery embolization. Hemoglobin was stable therafter.
The patient soon developed hypertensive urgency with blood pressure reaching 190/100 mmHg. The patient's only home medication for blood pressure was Carvedilol. Lisinopril 20mg PO daily was added and increased to maximum dosage, only partially relieving the hypertension. Losartan was added and uptitrated to 100mg PO daily. The patient's blood pressure normalized with average in 120s systolic by discharge. The patient was continued on this regimen as an outpatient. No hyperkalemia was observed.
Discussion
Page kidney is a rare but serious form of secondary hypertension from RAAS activation from renal parenchymal compression. Historically, a trial of either an ACE or ARB is indicated, with refractory cases being managed surgically. In this case, dual RAAS blockade was required for blood pressure control, which allowed surgical interventions, and their associated risk of morbidity and mortality, to be avoided.