11/15. Page kidney resulting from massive subcapsular hematoma. Complication of lumbar sympathetic nerve block. The Page kidney is a recognized cause of hypertension. A massive subcapsular hematoma caused by a lumbar sympathetic nerve block resulted in a Page kidney. To our knowledge, this sequence has not been reported. Small hematomas may be treated conservatively, but massive subcapsular hematomas should be decompressed when the patient is clinically stable. Diagnostic features, therapeutic considerations, and pertinent references are discussed. ( info) |
| Although urinary tract infection caused by bacteroides fragilis has been recognized since the turn of the century it is not frequently recognized in clinical practice. Only a small number of significant upper urinary tract infections in which bacteroides fragilis has had a significant pathogenic role have been reported previously. The use of systemic metronidazole in the treatment of this rare and unusually refractory form of urinary tract infection is described. ( info) |
| We describe a case of Page kidney following an infectious urinoma complicated by a pyelolithotomy. The most characteristic finding was the fact that this case resulted from constrictive perinephritis, not from any usual etiology such as perirenal hematoma. knowledge of the patient's medical history and split venous renin measurements were helpful in making a diagnosis. She had refractory hypertension during conservative medical therapy. Finally, a nephrectomy improved her hypertension. The value of venous renin sampling for reaching a diagnosis, and the medical and surgical therapeutic options are discussed. This report also reviews all previously described cases of Page kidney without hematomas. ( info) |
| A case of malacoplakia of the kidney is presented. The incidental finding of asymptomatic pyuria focused attention on the urinary system. Urologic evaluation concluded an avascular renal mass. The diagnosis of malacoplakia was established only after histologic studies of the surgical specimen were completed. Purulent perinephritis complicated the postoperative outcome. ( info) |
15/15. Hyperreninemic hypertension secondary to a subcapsular perinephric hematoma in a patient with polyarteritis nodosa. Page kidney is the name ascribed to a rare syndrome of hyperreninemic hypertension caused by unilateral compressive perinephritis. blood or fluid that accumulates in the perinephric subcapsular space compresses the renal parenchyma leading to ischemia. This syndrome is analogous to the description of cellophane-induced perinephritis by Page in 1939. Page kidney typically presents in healthy young men after blunt trauma to the flank or abdomen, although cases have been noted after medical or surgical interventions. We report a case of a Page kidney in a young man with hepatitis b virus-associated polyarteritis nodosa. The patient presented with severe hypertension, hypokalemia, hyperreninemia, and radiographic evidence of a unilateral subcapsular hematoma. Perinephric hemorrhage developed because of necrotizing vascular inflammation and spontaneous or traumatic vascular rupture. In patients who present with new-onset hypertension and hypokalemia with a history of trauma or coexisting vasculitis, the presence of a Page kidney should be considered. ( info) |