Abstract: PUB042
When Page Kidney Presents with Shock Instead of Hypertension
Session Information
Category: Cardiovascular-Kidney-Metabolic Health
- 602 Cardiovascular-Kidney-Metabolic Health: Clinical
Authors
- Hicks, Sydney, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, United States
- Khan, Hafiz Sarfraz Ahmad, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, United States
- Hasan, Irtiza, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, United States
Introduction
Page kidney (PK) is a rare phenomenon caused by external compression of the renal parenchyma, commonly from a subcapsular hematoma, resulting in secondary hypertension (HTN). Renal subcapsular hematomas are uncommon and usually associated with trauma, renal procedures, anticoagulation, or vascular instrumentation. We present an atypical case of PK following left heart catheterization (LHC) complicated by massive renal subcapsular hemorrhage presenting with hypotension/hemorrhagic shock rather than HTN.
Case Description
An 86-year-old male with CKD stage 3a, CAD status post multiple CABGs and PCIs, HTN, HFpEF, atrial fibrillation, and recent subdural hematoma status post decompressive craniotomy presented with chest pain and was admitted for non-ST-elevation MI. After multidisciplinary discussion regarding anticoagulation risk, heparin infusion was started with stable neuroimaging. On day 4, heparin was discontinued and he underwent LHC with PCI. The procedure was notable for a tortuous right common iliac artery requiring destination sheath placement. Cangrelor infusion was initiated post-procedure.
Shortly after PCI, the patient developed severe right upper quadrant pain, decreased responsiveness, hypotension & rapidly enlarging right flank ecchymosis. Hemoglobin acutely dropped to 4.7 g/dL from 10.8 g/dL. CT abdomen/pelvis with contrast revealed a 6.5 cm right renal subcapsular hematoma with active contrast extravasation and associated retroperitoneal hemorrhage. Due to concern for acute stent thrombosis, cangrelor infusion was continued. Renal angiography showed no active arterial bleeding. The patient remained intubated with vasopressor-dependent shock and received 6 units packed red blood cells and 4 units fresh frozen plasma with stabilization of hemoglobin and hemodynamics. He was ultimately discharged on dual antiplatelet therapy with aspirin & clopidogrel.
Discussion
This case highlights an atypical Page Kidney Phenomenon caused by massive renal subcapsular hemorrhage following PCI in the setting of anticoagulation & antiplatelet therapy. Although PK classically presents with HTN due to renal compression and RAAS activation, our patient instead developed hemorrhagic shock from extensive retroperitoneal bleeding, masking the expected physiology. Clinicians should suspect renal subcapsular hematoma in patients with flank pain, anemia, and hemodynamic instability after vascular instrumentation or antithrombotic therapy.