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Kidney Week

Abstract: PO1846

Page Kidney and Uncontrolled Hypertension: Rare Complication Post Kidney Biopsy

Session Information

Category: Hypertension and CVD

  • 1403 Hypertension and CVD: Mechanisms

Authors

  • Ammad, Naveria, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Bukhari, Marvi Manzoor, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
  • Abramovitz, Blaise William, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
Introduction

Page kidney is a rare phenomenon defined as an external compression of the renal parenchyma that can lead to hypertension and acute kidney injury. Compression of the renal parenchyma can occur from the formation of a subcapsular hematoma of traumatic or non-traumatic origin. This phenomenon can be seen as a rare cause of hypertension related to subcapsular hematoma formation following kidney biopsy. We report a case of a 34-year-old-male with chronic kidney disease who developed abdominal pain and uncontrolled hypertension within 24 hours of kidney biopsy, found to have imaging findings consistent with Page kidney as a complication of the procedure.

Case Description

A 34-year-old male patient with a history of HTN, CAD, and stage 3B CKD presented to the ER with left flank pain and hypertensive urgency with SBP > 200 mmHg one day following a native kidney biopsy. He underwent a kidney biopsy for evaluation of sub-nephrotic range proteinuria and unclear etiology of CKD. CT abdomen/pelvis with contrast demonstrated a new 3.5 cm left kidney subcapsular hematoma with perinephric and retroperitoneal extension. Abdominal pain worsened and repeat imaging showed expansion of the hematoma up to 24.5 cm. Before, during, and after kidney biopsy, the patient had well-controlled HTN with SBP range in the 130-140s mmHg. The day following the biopsy, SBP had risen to over 200 mmHg. Given his recent biopsy, significant HTN, and expansion of subcapsular hematoma on imaging, Page kidney was identified as the culprit leading to uncontrolled HTN. He was admitted to the ICU and started on a nicardipine drip with improvement in BP. Interventional radiology was consulted, and the patient underwent a left renal angiogram showing active extravasation at the hematoma site, which was then embolized. The patient achieved adequate BP control and the nicardipine drip was successfully weaned off. He was then transitioned back to his home oral antihypertensives.

Discussion

Page kidney refers to a condition in which there is an external force compressing the kidney which results in decreased kidney perfusion manifesting in a state of ischemia. This activates the RAAS system leading to secondary hypertension. Although many cases have previously been reported, Page kidney remains an uncommon cause, especially over recent years, of uncontrolled secondary hypertension and acute kidney injury.