Acute Page Kidney Following Renal Allograft Biopsy: A Complication Requiring Early Recognition and Treatment

Abstract

The acute Page kidney phenomenon occurs as a consequence of external compression of the renal parenchyma leading to renal ischemia and hypertension. Between January 2000 and September 2007, 550 kidney transplants and 518 ultrasound-guided kidney biopsies were performed. During that time, four recipients developed acute oligo-anuria following ultrasound-guided allograft biopsy. Emergent dopplerultrasounds were performed demonstrating absence of diastolic flow as well as a sub-capsular hematoma of the kidney. Prompt surgical exploration with allograft capsulotomy was performed in all cases. Immediately after capsulotomy, intraoperative Doppler study demonstrated robust return of diastolic flow. Three patients maintained good graft function, and one kidney was lost due to acute antibody-mediated rejection. We conclude that postbiopsy anuria associated with a subcapsular hematoma and acute absence of diastolic flow on doppler ultrasound should be considered pathognomonic of APK. All renal transplant specialists should be able to recognize this complication, because immediate surgical decompression can salvage the allograft.

The Native Kidney Biopsy

“…Although the development of Page kidney after allograft kidney biopsy has been described (0.8% of patients in a recent case series [40]), no patients with Page kidney after native kidney biopsy have been reported (41). The puncture of other organs is a rare complication of the PRB.…”

Hypertension and Hydronephrosis: Rapid Resolution of High Blood Pressure Following Relief of Bilateral Ureteric Obstruction

“…14 There have since been multiple descriptions of this phenomenon, for example following trauma or renal biopsy with increased renin secretion from the affected kidney and normalisation of blood pressure following surgical intervention. [15][16][17][18] There have similarly been clinical case reports of hypertension due to extrinsic renal compression from other causes such as paragangliomas 19 or splenic cysts. 20 Parenchymal compression by renal cysts may also lead to hypertension.…”

Page Kidney: A Case of Acute or Chronic Renal Failure & Refractory HTN Presenting after Renal Biopsy

“…A CT scan without contrast should be ordered immediately followed by prompt surgical evaluation. In the Page phenomenon the rapid acute rise in blood pressure can be very dangerous-resulting in stroke, MI, or worsening of the bleed itself [6]. In this case, we advocate the importance of rapid blood pressure control with intravenous anti-hypertensive medication to prevent the size of the hematoma from progressing, thereby worsening the Page phenomenon [7].…”