Page kidney – A rare case of secondary hypertension caused by perinephric hematoma

Abstract

About 5–10% of the cases of hypertension are caused due to a reversible secondary cause, especially in the younger population. A rare cause of secondary hypertension called page kidney, which is the external pressure on the kidneys causing the activation of reninangiotensin-aldosterone system mechanism. We present a case of a 56 year old female, with a history of uncontrolled hypertension in spite of being on 4 antihypertensive medications. She presented to the Emergency Room with hypertensive emergency and acute left middle cerebral artery ischemic stroke, for which thrombolysis was done with alteplase, after her BP was controlled. An emergent computed tomography abdomen was done for flank pain showed an acute left perinephric hematoma secondary to angiomyolipoma with possible mass effect on the left kidney, raising the possibility of page kidney. She was managed conservatively with angiotensin-converting enzyme (ACE) inhibitors. She was managed conservatively with angiotensin-converting enzyme(ACE) inhibitors and a further workup was done to assess the possibility of secondary hypertension. Page kidney is caused by external compression of the kidney by any cause including retroperitoneal or subcapsular hematoma, tumor, and cyst. This is a unique case, in which the patient most likely was having perinephric bleed secondary to renal angiomyolipoma causing long-standing secondary hypertension but was incidentally detected when the patient developed further bleeding when she was given alteplase for stroke. As per literature, nephrectomy has been advised, but with the advent of ACE inhibitors, patients have been conservatively without any intervention.