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Lind CA, Tjiattas-Saleski L. Exploration of Hypertension Following Traumatic Renal Hematoma Formation and Page Kidney Discussion. Cureus 2024; 16:e60468. [PMID: 38883132 PMCID: PMC11180518 DOI: 10.7759/cureus.60468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/15/2024] [Indexed: 06/18/2024] Open
Abstract
Page kidney is defined as a rare cause of secondary hypertension due to a subcapsular hematoma externally compressing the kidney resulting in the activation of the renin-angiotensin-aldosterone system (RAAS). This phenomenon consists of numerous etiologies including acute or chronic traumatic or non-traumatic events. In this case, we report on an acute unilateral hematoma following blunt renal trauma as the result of a fall from standing height treated with tissue plasminogen activator (tPA) infusion and image-guided drainage. Qualities within this case and how they are paralleled in the diagnosis of a Page kidney are explored. A brief review of current etiologies and management plans per the literature review will also be discussed.
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Affiliation(s)
- Caterina A Lind
- Emergency Medicine, Edward Via College of Osteopathic Medicine, Spartanburg, USA
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Kumarasinghe G, Sivasubramanium M, Ekanayake KB, Rambukwella D, Sanjaya B. A fatal misdiagnosis of page kidney - case report. Forensic Sci Med Pathol 2024:10.1007/s12024-024-00807-6. [PMID: 38613623 DOI: 10.1007/s12024-024-00807-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/15/2024]
Abstract
Page kidney is a condition where external compression of the renal artery and renal parenchyma leads to subsequent ischaemia and activation of renin-angiotensin-aldosterone axis. A 42-year-old female with hirsutism, hypertension and diabetes was diagnosed with a right adrenal mass and underwent laparoscopic adrenalectomy. Her hypertension worsened postoperatively and was managed medically. Subsequently she developed a right flank pain on the fifth postoperative day and died suddenly the next day. Autopsy revealed a pale body with cushingoid appearance. Surgical scars were healthy. Internal examination of the abdomen revealed a haemoperitoneum of 500 ml together with a large subcapsular haematoma measuring 1000 ml surrounding the right kidney, compressing the right renal artery. Kidneys were pale and the right kidney was soft and friable. Cortical surface of the right kidney demonstrated a possible surgical puncture site with an overlying thrombus together with a contused inferior vena cava. Other organs were pale but appeared otherwise normal. Histology revealed diffuse cortical necrosis of right kidney and features of adult respiratory distress syndrome in the lungs. Haemorrhagic shock following laparoscopic adrenalectomy for right adrenal tumor was declared as the cause of death, contributed by the development of the Page kidney. Trauma of several aetiologies including laparoscopic abdominal surgery may contribute to Page kidney. It presents with flank pain, hypertension and renal mass. Since postoperative blood loss usually manifests as hypotension, resulting hypertension may mislead the attending clinicians. Once diagnosed, it can be managed with surgical drainage and antihypertensives.
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Affiliation(s)
- Gayan Kumarasinghe
- Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
| | | | - Kasun Bandara Ekanayake
- Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Bandarage Sanjaya
- Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Koyanagawa K, Bahl S, Havryliuk T. A Rare Case of Page Kidney in a Young Man with Flank Pain. J Emerg Med 2024; 66:e369-e373. [PMID: 38278675 DOI: 10.1016/j.jemermed.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/03/2023] [Accepted: 10/01/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Page kidney is a rare condition in which an external compression of the kidney as a result of a hematoma or mass causes renal ischemia and hypertension. In a patient with flank pain, elevated blood pressure, and recent trauma, this condition should be considered. Since this condition was first described in 1939, more than 100 case reports have surfaced. CASE REPORT We describe the case of a 26-year-old man who presented to the Emergency Department with flank pain, vomiting, and elevated blood pressure. A computed tomography scan of the abdomen and pelvis confirmed the presence of a perinephric hematoma, and the interventional radiology team was consulted to resolve the Page kidney. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Symptoms seen in Page kidney may be similar to other more common diagnoses encountered in the emergency department. It is important to maintain a high suspicion and order imaging studies as needed, especially in the setting of trauma, or a recent procedure in the vicinity of the renal parenchyma.
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Affiliation(s)
| | - Sumeet Bahl
- Department of Interventional Radiology, The Brooklyn Hospital Center, Brooklyn, New York
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Zaw E, Bies JJ, Zay H, Massebo E, Hassan M, Prakash S, Htay T, Lane M. A Rare Case of Page Kidney With Superimposed Infection. Cureus 2023; 15:e50842. [PMID: 38249211 PMCID: PMC10798362 DOI: 10.7759/cureus.50842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
Page kidney (PK) is a rare renal condition characterized by external compression of the kidney, typically by a subcapsular hematoma, leading to resistant secondary hypertension due to hypoperfusion and ischemia. This hypertension is caused by the external compression of the kidney by a chronic subcapsular hematoma that activates the renin-angiotensin-aldosterone system (RAAS) system. Hematoma formation can result from external or internal trauma. The resolution of the hematoma can take months, and, in some cases, may necessitate a nephrectomy. Unresolved subcapsular hematomas can be complicated by infection, leading to sepsis, hospitalization, and the need for surgical drainage. This report presents a unique case of a 67-year-old female with a spontaneous left renal subcapsular hematoma that did not resolve with conservative measures and was complicated by superimposed infection requiring percutaneous drainage.
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Affiliation(s)
- Emerald Zaw
- Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA
| | - Jared J Bies
- Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA
| | - Hein Zay
- Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA
| | - Eyoab Massebo
- Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA
| | - Mariam Hassan
- Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA
| | - Swathi Prakash
- Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA
| | - Thwe Htay
- Medical Education, Texas Tech University Health Sciences Center El Paso, El Paso, USA
| | - Mariela Lane
- Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA
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Rezkalla A, Naseer M, Afzal A, Nashed A, Michael P. A Rare Case of Intravenously Managed Hypertensive Emergency Arising from a Perirenal Hematoma Subsequent to a Native Kidney Biopsy. J Community Hosp Intern Med Perspect 2023; 13:63-66. [PMID: 38596547 PMCID: PMC11000849 DOI: 10.55729/2000-9666.1266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/21/2023] [Accepted: 08/30/2023] [Indexed: 04/11/2024] Open
Abstract
Page kidney is a pathologic and rare occurrence caused by a compression of renal parenchyma leading to hypertension. When infiltrated or engulfed by extrinsic matter, the subcapsular region surrounding the renal tissue may cause blanket compression, leading to the activation of the renin-angiotensin-aldosterone system secondary to renal hypoperfusion. While most cases of Page kidney are secondary to blunt trauma to the costovertebral angle, herein we present a case of Page kidney due to renal parenchymal core needle biopsy. The rarity of our case is not due to the cause of such an incidence but because our case resulted in a hypertensive emergency treated with dual intravenous infusions.
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Affiliation(s)
- Abraam Rezkalla
- St. Joseph’s University Medical Center, 703 Main St, Paterson, NJ 07503,
USA
| | - Minha Naseer
- St. Joseph’s University Medical Center, 703 Main St, Paterson, NJ 07503,
USA
| | - Adil Afzal
- St. Joseph’s University Medical Center, 703 Main St, Paterson, NJ 07503,
USA
| | - Andrew Nashed
- St. Joseph’s University Medical Center, 703 Main St, Paterson, NJ 07503,
USA
| | - Patrick Michael
- St. Joseph’s University Medical Center, 703 Main St, Paterson, NJ 07503,
USA
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Bilateral Page kidney in a postpartum female: a case report. Ann Med Surg (Lond) 2023; 85:225-227. [PMID: 36845773 PMCID: PMC9949809 DOI: 10.1097/ms9.0000000000000196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/24/2022] [Indexed: 02/28/2023] Open
Abstract
Page kidney results from external compression of the kidney by a subcapsular hematoma and is one of the rare but treatable causes of secondary hypertension. The majority are traumatic or iatrogenic and often unilateral. Spontaneous bilateral Page kidney is rare. Case Presentation A 35-year P1 with gestational hypertension presented with a persistent postpartum elevation of blood pressure (BP). Imaging studies revealed bilateral renal subcapsular hematoma (left>right). She was managed with an angiotensin receptor blocker initially and ultrasound-guided percutaneous drainage of the collection for the optimal control of elevated BP. Clinical Discussion Ultrasonography and computed tomography of the kidneys are the most frequently used for diagnosing a Page kidney. Medical management with antihypertensive and regular follow-ups form the first line of treatment in Page kidneys. Percutaneous drainage, surgical decortication, laparoscopic intervention, and nephrectomy are necessary in cases of organized late hematomas. Conclusion Spontaneous bilateral Page kidney is a rare but potentially treatable and curable form of hypertension. Percutaneous drainage is an effective method to drain the hematoma and control elevated BP.
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Para SA, Wani MS, Ahmad MS, Hamid A, Lone SS, Singh S. Massive perinephric hematoma – A rare complication of extracorporeal shock wave lithotripsy. Urol Case Rep 2022; 45:102224. [PMID: 36160067 PMCID: PMC9489501 DOI: 10.1016/j.eucr.2022.102224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/24/2022] [Accepted: 09/11/2022] [Indexed: 11/29/2022] Open
Abstract
Extracorporeal shock wave lithotripsy is commonly used to fragment renal calculi. This treatment modality is considered safe with minimal complications. We report a case of massive retroperitoneal hematoma following extracorporeal shock wave lithotripsy in a patient with no comorbidity and normal coagulation parameters. Patient was managed conservatively and had excellent recovery with normal renal function.
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Affiliation(s)
- Sajad Ahmad Para
- Department of Urology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, 190011, India
- Corresponding author. Urology Sher-i-Kashmir Institute of Medical Sciences, c-18 quarter Soura, Srinagar, 190011, India.
| | - Mohammad Saleem Wani
- Urology and Renal Transplant, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | | | - Arif Hamid
- Urology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Sajad Sultan Lone
- Urology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Shashank Singh
- Urology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
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Cisneros R, Nair A, Kashyap R, Pineda-Solis K. Page phenomenon in a transplanted kidney: is it salvageable? BMJ Case Rep 2022; 15:e249625. [PMID: 36162963 PMCID: PMC9516073 DOI: 10.1136/bcr-2022-249625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A male in his late 70s with a history of an uncomplicated kidney transplantation 20 years prior was brought to the Emergency Department after experiencing blunt abdominal trauma following a motor vehicle collision. Imaging revealed a large perinephric haematoma, a retroperitoneal haematoma and multiple fractures. He was admitted to the intensive care unit where a renal haematoma was found to be expanding with ultrasonography (US) and developed renal dysfunction including anuria and hyperkalemia. His creatinine rose to twice his baseline and Doppler US showed elevated resistive indices, confirming extrinsic compression and causing a Page phenomenon. An open surgical exploration through the upper aspect of his Gibson incisional scar was performed followed by evacuation of the haematoma. An intraoperative US was done demonstrating good flow in the renal vessels. His postoperative course was uncomplicated and was discharged home with renal function back to baseline. On follow-up, he continued to have a good renal function.
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Affiliation(s)
- Rafael Cisneros
- School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Amit Nair
- Transplant Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Randeep Kashyap
- Transplant Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Karen Pineda-Solis
- Transplant Surgery, University of Rochester Medical Center, Rochester, New York, USA
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Rahman S, Imanzadeh A, Martin T, Ayyagari R. Page kidney: an unusual complication of image-guided native renal parenchymal biopsy - case report and literature review. Radiol Case Rep 2022; 17:2006-2010. [PMID: 35432668 PMCID: PMC9010687 DOI: 10.1016/j.radcr.2022.03.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 12/02/2022] Open
Abstract
Page kidney is a pathologic phenomenon in which extrinsic compression of renal parenchyma from a subcapsular collection causes secondary systemic hypertension, via activation of the renin-angiotensin-aldosterone system. Following the first description of Page kidney, the condition was most often recognized following blunt trauma to the flank. Increasingly, non-traumatic and iatrogenic etiologies of Page kidney have been described. We present a case of Page kidney as a complication of image-guided native renal parenchymal core needle biopsy. The current literature on etiologies, pathophysiology, and treatment options for Page kidney are summarized.
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Affiliation(s)
- Saumik Rahman
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
- Corresponding author.
| | - Amir Imanzadeh
- Department of Radiological Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Thomas Martin
- Department of Urology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Raj Ayyagari
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
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Ba Z, Xiao Y, He M, Liu D, Wang H, Liang H, Yuan J. Risk Factors for the Comorbidity of Hypertension and Renal Cell Carcinoma in the Cardio-Oncologic Era and Treatment for Tumor-Induced Hypertension. Front Cardiovasc Med 2022; 9:810262. [PMID: 35252390 PMCID: PMC8892205 DOI: 10.3389/fcvm.2022.810262] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Advances in tumor diagnosis and treatment, especially the use of targeted therapies, have remarkably improved the survival rate of patients with renal cell carcinoma (RCC), accompanied by higher hypertension (HTN) incidence among patients with RCC, reflecting the coming of a cardio-oncologic era. Therefore, for patients with RCC and HTN simultaneously, finding risk factors for the comorbidity and giving better clinical treatment have been urgent problems. In this review, we thoroughly investigated risk factors for the comorbidity of HTN and RCC based on preclinical and clinical studies. Firstly, RCC and HTN may have common risk factors, such as obesity, smoking, and other modifiable lifestyles. Secondly, RCC and HTN may lead to each other directly or indirectly by their therapies. We then discussed measures of reducing the comorbidity and treatment of HTN in patients with RCC. We also discussed the deficiency of current studies and pointed out future directions. In conclusion, this review aims to deepen the understanding of cardio-oncology and bring benefit to the population who are at high risk of getting or have already got RCC and HTN simultaneously.
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Affiliation(s)
- Zhengqing Ba
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Xiao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Ming He
- Department of Infectious Diseases, Peking University First Hospital, Beijing, China
| | - Dong Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hanyang Liang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiansong Yuan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Pulmonary Vascular Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Jiansong Yuan
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Ismail A, Elmansy H, Shahrour W, Prowse O, Kotb A. Late upper urinary tract urothelial carcinoma following radical cystectomy, presenting as page kidney. Asian J Urol 2021; 8:442-443. [PMID: 34765454 PMCID: PMC8566367 DOI: 10.1016/j.ajur.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/07/2020] [Accepted: 09/22/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Asmaa Ismail
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Hazem Elmansy
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Walid Shahrour
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Owen Prowse
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Ahmed Kotb
- Department of Urology, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
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Douvris A, Jegatheswaran J, Hadziomerovic A, Ruzicka M. Page kidney: Rare cause of acute kidney injury after complicated renal artery angioplasty. J Clin Hypertens (Greenwich) 2021; 23:1631-1633. [PMID: 34216535 PMCID: PMC8678673 DOI: 10.1111/jch.14318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/29/2022]
Abstract
The authors present a case of a patient who experienced a rare complication after attempted renal angioplasty and stenting, Page kidney. This patient presented with new onset hypertension secondary to bilateral renal artery stenosis and was referred for revascularization given hypertension refractory to medical management. The right renal artery underwent successful angioplasty and stenting; however, the left renal artery experienced recoil stenosis. Post‐procedure the patient developed acute kidney injury secondary to Page kidney from subcapsular and extracapsular hematoma. This was managed conservatively with transfusions and the hematoma and acute kidney injury self‐resolved over the next 4 months. This case highlights the importance of revascularization for refractory hypertension secondary to hemodynamically significant bilateral renal artery stenosis, the rare complication of Page kidney with attempted revascularization of renal artery stenosis and the involvement of a hypertension specialist in the decision of revascularization of renal artery stenosis.
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Affiliation(s)
- Adrianna Douvris
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Januvi Jegatheswaran
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Adnan Hadziomerovic
- Division of Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Marcel Ruzicka
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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Galos P, Hultström M, Creusen AD, Eggertsen G, Urdzik J, von Seth M. Case report: An unusual presentation of renal hypertension after damage control surgery. Int J Surg Case Rep 2021; 82:105872. [PMID: 33857767 PMCID: PMC8065272 DOI: 10.1016/j.ijscr.2021.105872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/04/2021] [Accepted: 04/04/2021] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Hypertensive crisis may be a life-threatening condition to any patient and represents an even more serious condition in trauma patients following severe hemorrhage. CASE PRESENTATION We present a case were surgical drape packing induced hypertensive crisis in a trauma patient, recently resuscitated from abdominal hemorrhage. CLINICAL DISCUSSION We argue that direct compression of the kidney by the surgical drapes induced hypersecretion of renin with a mechanism equal to Page kidney. The hypertensive crisis as well as the hyperreninemia was resolved after removing the surgical drapes, and the patient's condition returned to normal without any sequelae. CONCLUSION We encourage considering this unusual but important complication when packing of the abdomen has been carried out, and strongly recommend ruling out renin-mediated hypertension as a cause of post-operative hypertension in such cases.
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Affiliation(s)
- Peter Galos
- Department of Surgical Sciences, Uppsala University, Sweden.
| | | | | | - Gösta Eggertsen
- Department of Laboratory Medicine, Karolinska Institutet, Sweden
| | - Jozef Urdzik
- Department of Surgical Sciences, Uppsala University, Sweden
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Overview of spontaneous intraabdominal tumor hemorrhage: etiologies, imaging findings, and management. Abdom Radiol (NY) 2021; 46:427-440. [PMID: 32691111 DOI: 10.1007/s00261-020-02663-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/27/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023]
Abstract
Hemorrhage is a potential complication of benign and malignant tumors and tumor-like conditions in the abdomen. Patients often have non-specific presentations, although they may present critically ill and hemodynamically unstable. Imaging plays an important role not only in the diagnosis of hemorrhage but also in the detection and characterization of an underlying mass. Ultrasound, computed tomography, and magnetic resonance imaging are utilized in evaluating these patients, with each having particular strengths and limitations. Spontaneous tumor hemorrhage is most commonly seen in hepatic and renal lesions, although it can arise from nearly every abdominal organ. In this article, we will review principles of tumor hemorrhage, illustrate common and uncommon imaging features, and highlight different options for management.
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Page Kidney in a Child with Severe Pelviureteric Junction Obstruction. Case Rep Urol 2020; 2020:8883546. [PMID: 32884853 PMCID: PMC7455810 DOI: 10.1155/2020/8883546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/27/2020] [Accepted: 07/14/2020] [Indexed: 11/29/2022] Open
Abstract
There are various causes of Reno Vascular Hypertension in children reported in the literature. Amongst these, Page kidney gets a rare mention. This phenomenon is a result of the accumulation of blood or urine in the perinephric or subcapsular space, resulting in compression of renal parenchyma, microvascular ischemia, alteration in the renin-angiotensin apparatus, and high renin hypertension. It has been well documented and studied in adults. Only a few cases are reported in the paediatric population. We report a rare presentation of Page kidney in a 5 year 8 months old girl. She initially presented with Dietl's crisis secondary to left Pelviureteric Junction obstruction (PUJO) causing massive hydronephrosis. She developed Page kidney phenomenon after spontaneous rupture of the pelvicalyceal system formed a tight compressive urinoma. She was managed successfully with internal JJ stenting and ultrasound-guided aspiration of the urinoma followed by elective delayed Pyeloplasty. To our knowledge, this is the first documented case of Page kidney in a child with severe PUJO.
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Incidence and Risk Factors of Hypertension Following Partial Nephrectomy in Patients With Renal Tumors: A Cross-sectional Study of Postoperative Home Blood Pressure and Antihypertensive Medications. Clin Genitourin Cancer 2020; 18:e619-e628. [PMID: 32144048 DOI: 10.1016/j.clgc.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/01/2020] [Accepted: 02/02/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION We aimed to evaluate the incidence and risk factors for nephrectomy-related hypertension (NR-HT) in patients with renal tumors who underwent partial nephrectomy (PN) or radical nephrectomy (RN). PATIENTS AND METHODS A retrospective cross-sectional follow-up survey of postoperative home blood pressure (BP) and defined daily dose (DDD) of antihypertensive medications was conducted in patients with renal tumors who underwent PN (210 patients) or RN (120 patients), and they were compared. We evaluated the incidence and risk factors for NR-HT, defined as the addition of antihypertensive medications in doses of 1 DDD or more after surgery, or postoperative BP of 140/90 mmHg with an increase of 20 mmHg from preoperative BP with no reduction in dose of antihypertensive medications. RESULTS Both systolic (mean, 124 vs. 129 mmHg; P < .001) and diastolic BP (mean, 74 vs. 79 mmHg; P < .001) significantly increased after PN compared with RN. Systolic (P < .001) and diastolic (P = .003) BP increased significantly more after PN than after RN, and NR-HT was more frequent after PN than after RN (16% vs. 5%; P = .002). PN (odds ratio [OR], 2.93; P = .022) and higher postoperative peak C-reactive protein (OR, 2.34; P = .017) were independently associated with NR-HT. When limited to only the patients who underwent PN, acute kidney injury (OR, 2.65; P = .036) and higher postoperative peak C-reactive protein (OR, 2.54; P = .016) were independent risk factors for NR-HT. CONCLUSION PN may cause postoperative progression of hypertension possibly through renal parenchymal damage.
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Onuigbo MAC, Sharma V, Balogun OO, Ghimire A. Post-Renal Biopsy Acute Kidney Injury and Page Kidney from Intra-Renal Hematoma Aggravated by Reversible Contrast-Induced Nephropathy Following Renal Arterial Embolization. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e919701. [PMID: 31964858 PMCID: PMC6998796 DOI: 10.12659/ajcr.919701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Patient: Male, 73-year-old Final Diagnosis: Page kidney from intra-renal hematoma aggravated by reversible contrast-induced nephropathy following renal arterial embolization Symptoms: Flank pain • nausea • vomiting Medication: Apixaban Clinical Procedure: Kidney biopsy and subsequent renal arterial embolization Specialty: Nephrology
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Affiliation(s)
- Macaulay A Chukwukadibia Onuigbo
- Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Vivek Sharma
- Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Omotola O Balogun
- Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Allina Ghimire
- Division of Nephrology, Department of Medicine, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
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Warnich I, Nicolaou M, Sofianos Z, Pienaar JA, Varghese J. Page kidney: A rare cause of secondary hypertension. SA J Radiol 2019; 23:1762. [PMID: 31754544 PMCID: PMC6837813 DOI: 10.4102/sajr.v23i1.1762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/16/2019] [Indexed: 11/16/2022] Open
Abstract
Page kidney is a rare phenomenon that can present with hypertension. The presence of a subcapsular perirenal collection causes parenchymal compression leading to renal hypoperfusion. Subsequent activation of the renin–angiotensin–aldosterone system results in an increase in systemic blood pressure. The causes of renal subcapsular collections are varied, with most cases being secondary to post-traumatic haematomas. We present the case of a young hypertensive patient, treated as primary hypertension with persistently uncontrolled blood pressures. This was despite good treatment adherence. On further investigation, imaging identified the presence of bilateral subcapsular collections. This case illustrates the importance of a thorough workup in a young hypertensive patient with refractory hypertension. Given that Page kidney is curable, timeous intervention can save the patient from unnecessary medications and the morbidity of uncontrolled blood pressures.
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Affiliation(s)
- Ilonka Warnich
- Department of Diagnostic Radiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Nicolaou
- Department of Diagnostic Radiology, University of the Witwatersrand, Johannesburg, South Africa
| | - Zelia Sofianos
- Department of Diagnostic Radiology, Klerksdorp/Tshepong Hospital Complex, Klerksdorp, South Africa
| | - Jacobus A. Pienaar
- Department of Diagnostic Radiology, Klerksdorp/Tshepong Hospital Complex, Klerksdorp, South Africa
| | - Jacob Varghese
- Department of Diagnostic Radiology, Klerksdorp/Tshepong Hospital Complex, Klerksdorp, South Africa
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19
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Siddiqui MA, Mittal PK, Little BP, Miller FH, Akduman EI, Ali K, Sartaj S, Moreno CC. Secondary Hypertension and Complications: Diagnosis and Role of Imaging. Radiographics 2019; 39:1036-1055. [DOI: 10.1148/rg.2019180184] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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McFadden JD, Hawksworth JS. Page Kidney: An Unusual Complication of a Renal Transplant Biopsy. Case Rep Urol 2018; 2018:8768549. [PMID: 29854553 PMCID: PMC5941725 DOI: 10.1155/2018/8768549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/14/2018] [Indexed: 11/18/2022] Open
Abstract
Page kidney, a rare phenomenon whereby external compression of renal parenchyma can induce hypertension, can be caused by subcapsular hematoma following renal transplant biopsy. Surgical intervention is often warranted to salvage the transplant kidney. This is a case report of a patient with acute T-cell-mediated rejection and no other risk factors for postprocedural bleeding that developed Page kidney. The patient had no signs or symptoms for >24 hours from the time of biopsy, underscoring the need for awareness of this rare but potentially catastrophic complication of renal transplant biopsies.
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Affiliation(s)
- Jacob D. McFadden
- Department of Transplant Surgery and Department of Urology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD, USA
| | - Jason S. Hawksworth
- Department of Transplant Surgery and Department of Urology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD, USA
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21
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Zvavanjanja RC, Ashton AS. Page kidney secondary to subcapsular hematoma following percutaneous renal allograft biopsy. Radiol Case Rep 2018; 13:702-708. [PMID: 30046367 PMCID: PMC6056706 DOI: 10.1016/j.radcr.2018.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/18/2018] [Indexed: 02/04/2023] Open
Abstract
Percutaneous renal biopsy with ultrasound guidance is a helpful procedure regularly performed to obtain renal tissue diagnosis for rejection in the postrenal transplant setting; however, it is not without risks. We report the case of a 42-year-old male with end stage renal disease who developed a subcapsular hematoma, with subsequent hypertension and renal failure, compatible with acute page kidney as a complication of the renal biopsy. The ultrasound images demonstrated classic imaging appearances which all diagnostic and interventional radiologists should be aware of. The patient was managed successfully with conventional open surgical evacuation of the hematoma with return to baseline laboratories and vital signs after the procedure.
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22
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Affiliation(s)
- Pat W Whitworth
- Department of Radiology, Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, USA.
| | - Raymond B Dyer
- Department of Radiology, Wake Forest Baptist Medical Center, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, USA
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23
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Arslan S. Bilateral nontraumatic recurrent Page kidney. Radiol Case Rep 2017; 12:511-513. [PMID: 28828114 PMCID: PMC5552010 DOI: 10.1016/j.radcr.2017.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 04/11/2017] [Accepted: 05/19/2017] [Indexed: 11/19/2022] Open
Abstract
Page kidney is a rarely seen phenomenon leading to secondary hypertension and encountered most frequently due to traumatic or nontraumatic subcapsular hematoma. Such a compression in kidneys causes hypoperfusion and microangiopathic ischemia and activates renin-angiotensin-aldosterone system leading to hypertension. In this presentation, we report a rare case of bilateral Page kidney presenting with hypertension attacks due to spontaneous subcapsular hematoma developing in different kidneys at different times.
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Affiliation(s)
- Serdar Arslan
- Department of Radiology, Konya Training and Research Hospital, Konya, Turkey
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Chiu YL, Hu C, Lee SD, Chen PY, Wang CP. The role of renoscintigraphy and surgery in the management of Page kidney: A case report. Medicine (Baltimore) 2017; 96:e6560. [PMID: 28422842 PMCID: PMC5406058 DOI: 10.1097/md.0000000000006560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Page kidney is an uncommon condition that hypertension occurs secondary to microvascular ischemia and alternation of small-vessel hemodynamics due to external compression of renal parenchyma and activation of the renin-angiotensin-aldosterone system. There are no specific guidelines for the management of Page kidney in the literatures. PATIENT CONCERNS A 17-year-old teenager who had Fontan procedure for tricuspid and pulmonary atresia in early childhood suffered from sudden onset of severe left flank pain during cardiac catheterization procedure. Left renal artery active bleeding with renal parenchyma compression in association with renin-mediated hypertension led to the diagnosis of Page kidney. DIAGNOSES Page kidney was diagnosed in this case. INTERVENTIONS Urgent embolization was performed to treat left renal artery active bleeding. Because of decreased renal function with elevation of serum creatinine, inadequate blood pressure control with antihypertensive medication, and poor renal blood flow of left kidney, open drainage of perirenal hematoma was done 5 days after catheterization procedure. OUTCOMES After the operation, glomerular filtration rate improved immediately, and left flank pain and hypertension resolved at discharge. LESSONS The choice of the therapies for Page kidney depended on the clinical presentation of each case. This case pointed out the significance of renoscintigraphy and surgery in the management of Page kidney.
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Affiliation(s)
- Yu-Li Chiu
- aDepartment of Nuclear Medicine bSection of Pediatric Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Taiwan
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25
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Affiliation(s)
- Atsushi Ono
- Department of Nephrology, Faculty of Medicine, Saitama Medical University, Japan
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Çiftçi S, Stuart Wolf J. Laparoscopic treatment of Page kidney: a report of two cases and review of the literature. Turk J Urol 2015; 39:126-30. [PMID: 26328095 DOI: 10.5152/tud.2013.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 08/28/2012] [Indexed: 12/28/2022]
Abstract
Page kidney is defined as the external compression of the kidney, typically by a subcapsular hematoma, that leads to hypertension due to hypoperfusion and ischemia. The treatment options include medical anti-hypertensive treatment, percutaneous drainage, surgical decortication and nephrectomy. Laparoscopic decortication of Page kidney is a newly defined minimally invasive management technique. We describe 2 cases of Page kidney that failed to improve with percutaneous drainage but were successfully treated with the laparoscopic approach.
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Affiliation(s)
- Seyfettin Çiftçi
- Department of Urology, University of Michigan Health System, MI, USA
| | - J Stuart Wolf
- Department of Urology, University of Michigan Health System, MI, USA
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28
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Inoue M, Fujii Y, Yokoyama M, Saito K, Numao N, Kihara K. Progression of hypertension after partial nephrectomy in patients with renal tumors: A preliminary report. Int J Urol 2015; 22:797-8. [PMID: 25923977 DOI: 10.1111/iju.12794] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/17/2015] [Accepted: 03/22/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Masaharu Inoue
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
| | - Minato Yokoyama
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Kazutaka Saito
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Noboru Numao
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Kazunori Kihara
- Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
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Chen W, Kayler LK, Zand MS, Muttana R, Chernyak V, DeBoccardo GO. Transplant renal artery stenosis: clinical manifestations, diagnosis and therapy. Clin Kidney J 2014; 8:71-8. [PMID: 25713713 PMCID: PMC4310434 DOI: 10.1093/ckj/sfu132] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 11/13/2014] [Indexed: 01/04/2023] Open
Abstract
Transplant renal artery stenosis (TRAS) is a well-recognized vascular complication after kidney transplant. It occurs most frequently in the first 6 months after kidney transplant, and is one of the major causes of graft loss and premature death in transplant recipients. Renal hypoperfusion occurring in TRAS results in activation of the renin–angiotensin–aldosterone system; patients usually present with worsening or refractory hypertension, fluid retention and often allograft dysfunction. Flash pulmonary edema can develop in patients with critical bilateral renal artery stenosis or renal artery stenosis in a solitary kidney, and this unique clinical entity has been named Pickering Syndrome. Prompt diagnosis and treatment of TRAS can prevent allograft damage and systemic sequelae. Duplex sonography is the most commonly used screening tool, whereas angiography provides the definitive diagnosis. Percutaneous transluminal angioplasty with stent placement can be performed during angiography if a lesion is identified, and it is generally the first-line therapy for TRAS. However, there is no randomized controlled trial examining the efficacy and safety of percutaneous transluminal angioplasty compared with medical therapy alone or surgical intervention.
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Affiliation(s)
- Wei Chen
- Department of Medicine , University of Rochester School of Medicine and Dentistry , Rochester, NY , USA ; Department of Medicine , Albert Einstein College of Medicine , Bronx, NY , USA
| | - Liise K Kayler
- Department of Surgery , Albert Einstein College of Medicine , Bronx, NY , USA
| | - Martin S Zand
- Department of Medicine , University of Rochester School of Medicine and Dentistry , Rochester, NY , USA
| | - Renu Muttana
- Department of Medicine , Maimonides Medical Center , Brooklyn, NY , USA
| | - Victoria Chernyak
- Department of Radiology , Albert Einstein College of Medicine , Bronx, NY , USA
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30
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Krakoff LR. Adiposity and Risk for Hypertension. J Am Coll Cardiol 2014; 64:1003-4. [DOI: 10.1016/j.jacc.2014.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 07/01/2014] [Indexed: 10/24/2022]
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Shen Z, He W, Liu D, Pan F, Li W, Han X, Li B. Novel technique for the treatment of large subcapsular renal hematoma: combined use of percutaneous drainage and urokinase injection. Int Urol Nephrol 2014; 46:1751-5. [PMID: 24729103 DOI: 10.1007/s11255-014-0710-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 03/28/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of combined use of percutaneous drainage and urokinase injection to treat patients with large subcapsular renal hematoma. METHODS We retrospectively analyzed the data of 20 patients with large subcapsular renal hematoma who were treated with percutaneous drainage and urokinase at our institutes between 2002 and 2010. Percutaneous drainage of the hematoma was performed after bleeding stopped. Then, urokinase was injected into the hematoma cavity per our protocol every 3 days. During the treatment and follow-up period, the diameter of hematoma was assessed by ultrasonography and enhanced computed tomography (CT) in all cases. Complete blood count, serum creatinine and blood pressure were evaluated as well. Follow-up periods ranged from 12 to 60 months (mean 24.1 ± 11.5 months). RESULTS Percutaneous renal hematoma drainage combined with urokinase injection was successfully performed in all the patients. After sufficient drainage, all of the patients were free from their symptoms. The average time to pain relief was 10.8 ± 2.1 days after percutaneous drainage, and the total duration of drainage was 28 ± 5.1 days. Relative to baseline, there was reduction in the diameter of hematoma evaluated by the enhanced CT scan after treatment (from 11.7 ± 3.1 to 2.8 ± 1.0 cm). During long-term follow-up, active bleeding, hypertension, renal function impairment or infectious complications were not found. CONCLUSIONS This study revealed that combined use of percutaneous drainage and urokinase injection was a safe and effective treatment for patient with large subcapsular renal hematoma.
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Affiliation(s)
- Zhou Shen
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277, Jiefang Road, Wuhan, 430022, Hubei, China
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Neild GH, Sandal S, Zand MS. Page kidney phenomenon secondary to an atypical presentation of Erdheim-Chester disease. Clin Kidney J 2013; 6:547-8. [PMID: 26120451 PMCID: PMC4438401 DOI: 10.1093/ckj/sft086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 07/03/2013] [Indexed: 12/24/2022] Open
Affiliation(s)
- G H Neild
- Division of Nephrology, School of Medicine and Dentistry , University of Rochester Medical Center , Rochester, NY , USA
| | - Shaifali Sandal
- Division of Nephrology, School of Medicine and Dentistry , University of Rochester Medical Center , Rochester, NY , USA
| | - Martin S Zand
- Division of Nephrology, School of Medicine and Dentistry , University of Rochester Medical Center , Rochester, NY , USA
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Traumatic page kidney induced hypertension in critical care: immediately resolved or long-term resistant problem. Case Rep Crit Care 2013; 2013:201424. [PMID: 24829818 PMCID: PMC4010009 DOI: 10.1155/2013/201424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 06/28/2013] [Indexed: 11/18/2022] Open
Abstract
Page kidney is a well-known phenomenon causing hypertension, due to compression of renal parenchyma by a subcapsular hematoma, of either traumatic or non-traumatic origin. The main therapeutic approach is based on surgical approach (nephrectomy or hematoma evacuation) and antihypertensive treatment. In this paper we present a post-traumatic case of Page Kidney in a Critical Care unit. We discuss different therapeutical opportunities to extremely elevated systemic blood pressure resistant to traditional drug therapy.
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Turgutalp K, Kiykim A, Özhan O, Helvaci I, Ozcan T, Yildiz A. Comparison of diagnostic accuracy of Doppler USG and contrast-enhanced magnetic resonance angiography and selective renal arteriography in patients with atherosclerotic renal artery stenosis. Med Sci Monit 2013; 19:475-82. [PMID: 23778330 PMCID: PMC3692376 DOI: 10.12659/msm.889035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background There are many systemic complications of conventional selective renal arteriography (SRA), such as contrast-mediated nephropathy. Contrast-enhanced magnetic resonance angiography (CE-MRA) and renal artery Doppler ultrasonography (DUSG) have been used increasingly for renal artery stenosis (RAS). The aim of this study was to evaluate the accuracy of CE-MRA and DUSG as used for diagnosis of RAS. Material/Methods We divided 130 consecutive patients investigated for resistant hypertension into 2 groups based on age: group 1 was patients <60 years old and group 2 was patients >60 year. DUSG, CE-MRA, and SRA were performed in group 1 and group 2 patients. Results Seventy-two patients (24 males [M], 48 females [F]) in group 1, and 58 patients (26 M, 32 F) in group 2 were included in the study. In the evaluation of clinically significant renal artery stenosis with DUSG, in group 1 the overall sensitivity was 83.33% and overall specificity was 81.82%, and in group 2 they were 69.23% and 0%, respectively, when compared with SRA. In the evaluation of clinically significant renal artery stenosis with CE-MRA, the overall sensitivity and specificity were 92.31% and 36.36%, respectively, in group 1 and 100.00% and 73.33%, respectively in group 2, when compared with SRA. Conclusions CE-MRA is an accurate, non-invasive method for the diagnosis of RAS in patients above 60 years of age and DUSG may be the choice of diagnostic method for RAS in patients under 60 years of age.
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Affiliation(s)
- Kenan Turgutalp
- Department of Internal Medicine, Division of Nephrology, School of Medicine, Mersin University, Mersin, Turkey.
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