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Page Kidney

Physiology Review. Decrease in renal perfusion pressure causes juxtaglomerular cells of the afferent arteriole to secrete reninRenin catalyzes conversion of angiotensinogen ? angiotensin IAngiotensin-converting enzyme catalyzes the conversion of angiotensin I ? angiotensin IIAngiotensin II stimul

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Page Kidney

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    1. Page Kidney Liz Dehmer AM Report 4/21/09

    2. Physiology Review Decrease in renal perfusion pressure causes juxtaglomerular cells of the afferent arteriole to secrete renin Renin catalyzes conversion of angiotensinogen ? angiotensin I Angiotensin-converting enzyme catalyzes the conversion of angiotensin I ? angiotensin II Angiotensin II stimulates the secretion of aldosterone by the adrenal cortex Aldosterone increases Na+ reabsorption by the renal distal tubule thereby increasing ECF volume, blood volume and arterial pressure

    3. Page Kidney Occurs when the kidney is compressed by a subcapsular or perirenal process causing renal ischemia and activation of the renin-angiotensin-aldosterone axis leading to hypertension Described by Dr. Irvine Page in 1939. He performed an experiment in which he wrapped a canine kidney with cellophane and described an intense inflammatory response to the foreign material producing constrictive perinephritis, compression of the kidney parenchyma and hypertension.

    4. Page Kidney Page also proved that extirpating the affected kidney could cure the hypertension He wrote the first case report in 1955 of a football player who suffered a blunt injury to the kidney producing a renal hematoma and renin-mediated hypertension Hypertension secondary to compression of the kidney has since been called “Page kidney”

    5. Causes of Page Kidney Bleeding due to trauma Contact sports MVA Bleeding s/p intervention Post-operative Kidney biopsy Extra-corporeal shock wave lithotripsy Sympathetic nerve block Spontaneous bleeding Pancreatitis Warfarin therapy Polyarteritis nodosa Tumor Non-bleeding causes Pararenal lymphoceles Large simple cysts Retroperitoneal paraganglioma Urinoma Perirenal pseudocysts Peritransplant lymphocele

    6. Diagnosis of Page kidney *Imaging studies: ultrasound, CT scan, MRI *Can also obtain renin levels from both renal veins to confirm hyperreninemia *CT scan here shows a R-sided subcapsular hematoma with small calcification at the arrow

    7. Treatment of Page kidney Medical therapy Block the renin-angiotensin-aldosterone axis: ACE inhibitor, ARB, spironolactone Other anti-hypertensive agents Surgical therapy Percutaneous evacuation of perirenal hematoma Open drainage of hematoma Nephrectomy **longstanding hematoma can organize into fibrous pseudocapsules or can cause irreversible renal parenchymal damage**

    8. References Bakri, Rashed et al. Three ‘Pages’ in a chapter of accidents. Nephrology Dialysis Transplantation 2003; 18: 1917-1919. Diamond, Joseph A. Hypertension due to Perinephric Compression: The “Page” Kidney. American Journal of Hypertension 2001; 14:305. Sterns, Richard et al. ‘Page Kidney’ Hypertension Caused by Chronic Subcapsular Hematoma. Archives of Internal Medicine 1985; 145: 169-171.

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