Hypertension Due to Renal Compression Resulting From Subcapsular Hematoma

Engel, William J.; Page, Irvine H.

doi:10.1016/s0022-5347(17)67466-4

Cited by 139 publications

(41 citation statements)

References 4 publications

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“…9 With the exclusion of active bleeding requiring emergency surgery, the worst complication is "Page syndrome," a well-known condition caused by renal parenchyma compression, whose typical presentation is distinguished by acute impairment of renal function, anuria, and hypertension. 10 The generally accepted pathophysiology of this phenomenon is based on the hypoperfusion, ischemia, and activation of the renin-angiotensin-aldosterone system secondary to compression. 11 More recently, rather than activation of the renin-angiotensin-aldosterone system, an interstitial nephritis due to inflammation has been proposed, with mycophenolate mofetil having some role in preventing the inflammation and thus the hypertension.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Sarno

Ferrara²,

Cerbone³

et al. 2017

Exp Clin Transplant

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A 62-year-old male patient with diabetes underwent deceased-donor kidney transplant at our transplant unit. At reperfusion, a small and clinically not significant subcapsular hematoma was noted. The patient's postoperative course was characterized by delayed graft function since the beginning but was further complicated on postoperative day 6 by evidence (shown at daily Doppler ultrasonography) of a wide increase of the hematoma. The hematoma, which was just visible before, was now leading to graft compression because it covered up to two-thirds of the cortical surface. The patient showed no hemodynamic instability and showed no significant drop in hemoglobin values. Capsulotomy was not performed because it was deemed too risky. The patient was given strict follow-up with Doppler ultrasonography and high-resolution imaging techniques (magnetic resonance imaging and computed tomography scan). In the following days, spontaneous resolution of the hematoma and progressive improvement of Doppler findings were observed, which preceded full recovery of graft function. Conservative management, in hemodynamically stable patients, seems to be a valid approach of this condition. By avoiding surgery or other interventional procedures, a conservative approach allows reduced risk of further complications. Strict monitoring with Doppler ultrasonography is a valid tool for follow-up, along with high-resolution imaging techniques such as magnetic resonance imaging and computed tomography to confirm diagnosis.

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Section: Discussionmentioning

confidence: 99%

Untitled

Sarno

Ferrara²,

Cerbone³

et al. 2017

Exp Clin Transplant

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“…Engel and Page were the first to describe a clinical case of hypertension caused by SRH, which improved following a nephrectomy. A subcapsular hematoma usually compressed the kidney and was associated with high blood pressure and occasional renal failure in the patient (6). Percutaneous drainage or the use of percutaneous pigtail catheters, laparoscopic decortication, or the combined use of percutaneous drainage and urokinase injection may promote hematoma resolution in patients with stable vital signs; however, this therapy may induce unbearable pain or renal compression even with a solitary kidney (10).…”

Section: Discussionmentioning

confidence: 99%

Sudden onset of a huge subcapsular renal hematoma following minimally invasive ureteroscopic holmium laser lithotripsy: A case report

Zhang

2015

Experimental and Therapeutic Medicine

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Abstract. The postoperative complication rate of ureteroscopic lithotripsy (URSL) is low, and the most frequent complication is fever. Thus, urological surgeons often neglect or are unaware of subcapsular renal hematoma (SRH) as a rare complication following URSL. Although a SRH after undergoing URSL is uncommon, the occurrence may be fatal. The current study reports on a rare life-threatening case that occurred recently at Zhongnan Hospital (Wuhan, China). A 24-year-old male patient presented with a large SRH (11x14x11 cm) after undergoing a failed, but minimally invasive URSL with a holmium laser. The presence of the large SRH was confirmed by computerized tomography imaging. The patient underwent conservative management, which prevented hematoma enlargement, and no further treatment was conducted. In conclusion, SRH, although rare following URSL, should be noted by the urological surgeon.

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“…13 The first clinical report of a so-called "Page kidney" was by Engel in 1954 in a patient who developed hypertension as a result of a renal sub-capsular hematoma. 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.…”

Section: Discussionmentioning

confidence: 99%

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

Chalisey

Karim

2012

J GEN INTERN MED

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Hypertension secondary to hydronephrosis is not commonly reported in the medical literature. Tubuloglomerular feedback and the renin-angiotensin-aldosterone axis are thought to mediate this process. We describe a patient presenting with acute kidney injury and bilateral hydronephrosis secondary to pelvic malignancy in which peripheral venous renin and aldosterone were elevated. Her blood pressure improved rapidly following insertion of bilateral nephrostomies. The speed of resolution of hypertension following relief of obstruction suggests that humorally mediated vasoconstriction can play an important role in the mechanism by which hydronephrosis causes hypertension. We also discuss other causes of renal parenchymal compression that may lead to the development of hypertension.

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Hypertension Due to Renal Compression Resulting From Subcapsular Hematoma

Cited by 139 publications

References 4 publications

Untitled

Untitled

Sudden onset of a huge subcapsular renal hematoma following minimally invasive ureteroscopic holmium laser lithotripsy: A case report

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

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