Page kidney secondary to subcapsular hematoma following percutaneous renal allograft biopsy

Abstract

Percutaneous renal biopsy with ultrasound guidance is a helpful procedure regularly performed to obtain renal tissue diagnosis for rejection in the postrenal transplant setting; however, it is not without risks. We report the case of a 42-year-old male with end stage renal disease who developed a subcapsular hematoma, with subsequent hypertension and renal failure, compatible with acute page kidney as a complication of the renal biopsy. The ultrasound images demonstrated classic imaging appearances which all diagnostic and interventional radiologists should be aware of. The patient was managed successfully with conventional open surgical evacuation of the hematoma with return to baseline laboratories and vital signs after the procedure.

Acute Page kidney after angioplasty in kidney transplant allografts

“…There is no definitive consensus on the treatment of APK. However, large subcapsular haematomas require an aggressive approach to preserve as much kidney function as possible and prevent long-term complications [ 8 ]. Although haematomas or collections that cause APK can be drained percutaneously, surgical capsulotomy is mandatory in cases of uncontrolled pain, signs of arterial ischaemia or rapidly growing haematomas due to active bleeding [ 4 , 7 , 9 ].…”

Page kidney complicating kidney biopsy after stopping Apixaban: A physician's dilemma

“…The working diagnosis was that of Page kidney producing the initial increase in serum creatinine from a baseline of 1.31 mg/dL to 1.86 mg/dl on admission[ 1 3 ] [ Figure 1 ]. Serum creatinine, which was stable for the previous 2 years was 1.31 mg/dL 4 weeks before the kidney biopsy.…”

“…On admission, the serum creatinine had significantly increased to 1.86 mg/dL, consistent with acute kidney injury associated with Page kidney. [ 1 2 3 ] He subsequently developed reversible contrast-induced nephropathy following the double exposure to iodinated contrast on admission day– first, from the contrast-enhanced CT examination, and second, during the coil embolization procedure[ 4 ] [ Figure 1 ].…”

“…[ 2 ] More recently, this syndrome has also been described following intrarenal mechanisms such as sub-capsular and renal parenchymal hematomas, renal cysts, and renal tumors. [ 2 3 ] We describe Page kidney complicating ultrasound-guided right native kidney biopsy in a 73-year-old Caucasian male after withholding Apixaban, 3 days before the renal biopsy procedure and had restarted the Apixaban 3 days post-procedure. The evidence-base to guide peri-procedural management of NOACs is inadequate.…”

Clinical use of renal point-of-care ultrasound after extracorporeal shock wave lithotripsy

“…The sonographic appearance of a subcapsular renal hematoma is usually a crescent-shaped or ellipsoid hyper-, iso- or hypoechoic lesion located around the kidney in the subcapsular space. Hematomas can appear heterogenous and hyperechogenic in the acute phase, becoming more hypoechoic or cystic over time [8, 9]. Technically, the kidneys are usually well identified using a standard curvilinear probe.…”