Traumatic page kidney induced hypertension in critical care: immediately resolved or long-term resistant problem

Exploration of Hypertension Following Traumatic Renal Hematoma Formation and Page Kidney Discussion

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.

Bilateral nontraumatic recurrent Page kidney

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.

Page kidney due to a renal pseudocyst in a setting of pancreatitis

Pancreatic pseudocysts are notorious for their extension beyond the normal confines of the pancreatic bed due to dissection of the enzymatic pseudocyst fluid along fascial planes. Such collections of pancreatic juice may compress the kidney. Extension of the pseudocyst into the perirenal space is, however, uncommon. We report a case of pseudocyst of pancreas lying in the subcapsular plane of the left kidney with a patent communication with the pancreatic duct (pancreaticorenal fistula). The compressive effect of the pseudocyst on the kidney compromised intrarenal perfusion as evidenced by a faint nephrogram but a normal renal artery. This led to renin-angiotensin-aldosterone mediated hypertension-the Page kidney phenomenon. Extensive literature search revealed our case to be the only one to describe such an occurrence.