Page kidney induced emergent hypertension status post renal biopsy a case report

Abstract

Background

Page kidney is a rare cause of secondary hypertension arising from a subcapsular hematoma or mass compressing the kidney leading to increased arterial hypertension. Common causes of expansive kidney parenchymal bleeding are due to blunt trauma or less often iatrogenic causes, such as renal biopsy. Most of the time the secondary hypertension is resolved by evacuating the hematoma by stopping the bleeding via renal arterial embolization (RAE).

Case report

We discuss a 23-year-old female with a past medical history of hypertension, chronic kidney disease, status post left renal biopsy three days prior to evaluation who presented to the emergency department with severe left flank pain. From initial evaluation in the emergency department, a large expansive subcapsular hematoma was identified on imaging suggesting Page kidney causing the hypertensive emergency. The patient was managed with renal arterial embolization to control bleeding and blood pressure medications.

Why should an emergency physician be aware of this

Emergency physicians should be able to identify this rare cause of secondary hypertension to initiate proper management. Immediate blood pressure control, imaging and appropriate consultations should be initiated. Identifying sources of active bleeding is crucial for definitive management as was in the case which we presented. Quick identification of Page kidney is crucial to managing life threatening secondary hypertension, preventing renal failure, and addressing any sources of active hemorrhage.