Kidney Week

Abstract: PUB045

Page Kidney: When Minimally Invasive Interventions and Medical Therapy Become Essential

Session Information

• Publication Only

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Del Valle Vega, Sarybell J., Universidad de Puerto Rico Recinto de Ciencias Medicas, San Juan, San Juan, Puerto Rico

Sarybell J. Del Valle Vega, MD, MBA

• Vazquez Morales, Emily, Universidad de Puerto Rico Recinto de Ciencias Medicas, San Juan, San Juan, Puerto Rico

Emily Vazquez Morales, MD

• Ocasio Melendez, Ileana E., Universidad de Puerto Rico Recinto de Ciencias Medicas, San Juan, San Juan, Puerto Rico

Ileana E. Ocasio Melendez, MD, FASN

• Rivera Rios, Jeaneishka Marie, Universidad de Puerto Rico Recinto de Ciencias Medicas, San Juan, San Juan, Puerto Rico

Jeaneishka Marie Rivera Rios, MD

Introduction

Subcapsular renal hematomas have been reported in the setting of kidney transplant, renal biopsies, and traumatism with increasing incidence of iatrogenic causes. Page kidney phenomenon results from renal compression by a subcapsular hematoma leading to uncontrolled activation of the Renin-Angiotensin-Aldosterone System (RAAS), resulting in secondary hypertension and acute kidney injury (AKI). Although guidelines for management of hypertension and AKI in Page kidney have been proposed, protocols for prioritizing minimally invasive procedures after RAAS inhibitor therapy are an evolving field.

Case Description

A 63 year-old male with hypertension, pre-diabetes, and obstructive sleep apnea was hospitalized to the Trauma Unit after sustaining a ground-level fall presented with left-sided abdominal and chest discomfort. Initial vital signs were only remarkable for hypertension (135/79mmHg). Laboratory assessment showed leukocytosis, anemia, and increased serum creatinine (1.83 mg/dL). Ultrasound performed by trauma surgery team demonstrated a right pleural effusion. Abdominal/Pelvis CT demonstrated a large left subcapsular hematoma surrounding the entirety of the left kidney measuring approximately 7.3 cm AP x 2.8 cm in TR x 10.0 cm long. Hospitalization course was remarkable for worsening hypertension and left flank tenderness without signs of edema for which Nephrology service was consulted. Direct renin concentration was tested due to Page Kidney suspicion, resulting in elevated levels of 195 pg/mL. Due to worsening hypertension (>160/80) and rising serum creatinine (1.95 mg/dL), patient underwent hematoma evacuation by Interventional Radiology service with improvement of hypertension and transient improvement of AKI.

Discussion

Management of Page kidney often involves medical therapy as initial management, however, selective prioritization of minimally invasive procedures for unusually large hematomas have demonstrated favorable outcomes on kidney function and hypertension. Debate has arisen as to which pathway to prioritize in such instances as there are minimal protocols established to target the underlying cause of this pathology, however, minimally invasive interventions may be considered as initial management in trauma patients with large perirenal hematomas with concerns for worsening hypertension and deteriorating renal function.