Page kidney: an unusual complication of image-guided native renal parenchymal biopsy - case report and literature review

Abstract

Page kidney is a pathologic phenomenon in which extrinsic compression of renal parenchyma from a subcapsular collection causes secondary systemic hypertension, via activation of the renin-angiotensin-aldosterone system. Following the first description of Page kidney, the condition was most often recognized following blunt trauma to the flank. Increasingly, non-traumatic and iatrogenic etiologies of Page kidney have been described. We present a case of Page kidney as a complication of image-guided native renal parenchymal core needle biopsy. The current literature on etiologies, pathophysiology, and treatment options for Page kidney are summarized.

Keywords: Biopsy; Hypertension; Interventional; Kidney; Percutaneous.

Fig. 1

Preprocedural limited CT (A) demonstrating biopsy target with substantial peri-renal fibrosis (white arrow). Intra-procedural CT (B) demonstrating position of the biopsy needle. Post-biopsy CT (C) demonstrating new right subcapsular hematoma (white arrow).

Fig. 2

Arterial phase (A) and parenchymal phase (B) images of a right renal angiogram demonstrate no active arterial abnormality, but there is substantial extrinsic compression of the renal parenchyma by the subcapsular hematoma (white arrows).

Fig. 3

Grayscale (A) and Color/Spectral Doppler images (B) of the right kidney re-demonstrate the large right subcapsular hematoma, with elevated peak systolic velocity and reversed diastolic flow in the main renal artery.

Fig. 4

Non-contrast CT of the abdomen re-demonstrating the right renal subcapsular hematoma with associated persistent right renal nephrogram from prior angiography (white arrow). Also noted is the well-circumscribed subcapsular hematoma (white arrowheads).