Page Kidney Phenomenon: A Case Report and Literature Review

1Atlanta Medical Center, Atlanta, GA
2Atlanta Medical Center, Atlanta, GA
3Atlanta Medical Center, Atlanta, GA
4Atlanta Medical Center, Atlanta, GA
5Atlanta Medical Center, Atlanta, GA

Meeting: Hospital Medicine 2008, April 3-5, San Diego, Calif.

Abstract number: 132

Case Presentation:

This is a 29‐year‐old African American man who suffered from a work‐related crush injury leading to multiple complications including maxillary and sacral fractures as well as kidney and liver lacerations. He underwent multiple orthopedic surgeries and had a hospital course complicated by severe anemia (requiring blood transfusions), respiratory failure, and refractory hypertension. His condition improved, and he was transferred to the rehabilitation unit, where he continued to have poorly controlled hypertension, and internal medicine was consulted for hypertension management. History was remarkable for a family history of hypertension; no known history of renal disease. Patient denied any familial premature deaths due to heart disease or arrhythmias. Physical exam showed mild tachycardia and surgical scars. Laboratory analysis was significant for anemia, hyponatremia, leukocytosis, and mild renal insufficiency with creatinine determinations between 1.2 and 1.6 mg/dL. Urinalysis findings were consistent with UTI. Because of suspicion of a secondary cause of hypertension, renal ultrasound with a Doppler flow study was ordered. Results showed an 8‐cm left pelvic kidney with no blood flow and an adequately perfused 13‐cm right kidney that was located properly in the retroperineum. A preliminary diagnosis of renal artery stenosis was made, and CT angiography was ordered for confirmation. This study showed not only that both renal arteries were patent but also that the left pelvic kidney contained a subcapsular hematoma. This patient was then diagnosed with Page kidney. Patient declined surgery and opted for medical management. Hypertension ultimately responded well to ACE inhibitor and angiotensin receptor blocker combination therapy.

Discussion:

Page kidney phenomenon is a rare cause of secondary hypertension. There have been roughly 100 cases reported in the United States from 1955 to the present. The most common clinical scenario is a young, healthy athlete who sustains abdominal trauma and develops a subcapsular renal hematoma leading to compression of the kidney with associated renin‐mediated hypertension. Because of the rarity of the disease and the lack of controlled clinical trials, there are no clear recommendations about the diagnosis and treatment of Page kidney. Experiments with rats showed that removal of the affected kidney led to a cure of the condition.

Conclusions:

The purpose of reporting this case is to increase general awareness of this rare condition and to provide an up‐to‐date literature review.

Author Disclosure:

M. Carrington, none.

To cite this abstract:

Carrington M, Pimentel‐Brugal E, Pimentel C, Ramirez M, Lim T. Page Kidney Phenomenon: A Case Report and Literature Review. Abstract published at Hospital Medicine 2008, April 3-5, San Diego, Calif. Abstract 132. Journal of Hospital Medicine. 2008; 3 (suppl 1). https://www.shmabstracts.com/abstract/page-kidney-phenomenon-a-case-report-and-literature-review/. Accessed October 19, 2019.

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