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Kidney Week

Abstract: PO1845

Page Kidney: A Case of Spontaneous Subcapsular Hemorrhage Secondary to Anticoagulation

Session Information

Category: Hypertension and CVD

  • 1403 Hypertension and CVD: Mechanisms

Authors

  • Mehta, Smit P., Advocate Christ Medical Center, Oak Lawn, Illinois, United States
  • Alter, David, Advocate Christ Medical Center, Oak Lawn, Illinois, United States
  • Lerma, Edgar V., Advocate Christ Medical Center, Oak Lawn, Illinois, United States
Introduction

Page kidney is a rare condition caused by external compression on the renal parenchyma resulting in hypo-perfusion, activation of the renin-angiotensin-aldosterone system, and secondary hypertension. The etiologies of Page kidney include trauma, iatrogenic, spontaneous hematomas, and extrarenal compression.

Case Description

52-year-old male with a history of polycystic kidney disease (PCKD) on hemodialysis, atrial fibrillation, and aortic stenosis s/p mechanical valve replacement on Warfarin presented to the hospital for acute left flank pain. Pain was described as severe. On exam, the patient was afebrile and hemodynamically stable. Labs were notable for WBC 11.8, Hgb 7.4, and INR 2.4. CTA demonstrated a large hematoma originating from the left kidney measuring 14.3 x 12.7 cm. There were additional findings concerning for active arterial extravasation and compression of renal parenchyma. Patient was transfused 1 unit of PRBC's and admitted to the intensive care unit. While admitted, he became progressively more hypertensive despite escalating antihypertensive therapy. He ultimately underwent angiography and coil embolization to stop the bleed. Following successful coil embolization, his blood pressure normalized and anti-hypertensive medications were titrated off.

Discussion

Our case is unique in that it is the first case of a spontaneous bleed secondary to anticoagulation in the setting of PCKD. The combination of PCKD in a patient with significant need for ongoing anti-coagulation results in a dramatic increase in incidence of Page kidney.