What is Page Kidney?
Page kidney or Page phenomenon is a rare and treatable condition where the kidney is externally compressed leading to high blood pressure. This high blood pressure is caused by the activation of the body’s renin-angiotensin-aldosterone system, which controls blood pressure and fluid balance.
Young individuals diagnosed with high blood pressure are often subject to several tests to exclude secondary causes of the condition. Despite an increase in instances of high blood pressure among young people over the past decade, most cases are simply diagnosed as essential or primary high blood pressure.
Given the continuous pressure on healthcare systems worldwide, generally in terms of finances, it’s suggested that doctors should limit routine tests to a basic kit for patients initially diagnosed with high blood pressure. More advanced tests like kidney imaging should be performed only when there’s reason to suspect more complex underlying health conditions.
In most areas, a kidney ultrasound is part of the initial tests done, but it isn’t always easily available. Because of this, young patients are frequently diagnosed with primary high blood pressure, which can result in a delay in diagnosing secondary high blood pressure caused by conditions like the Page phenomenon.
What Causes Page Kidney?
The kidneys are protected by a smooth, sturdy outer layer that doesn’t have much extra room. If liquid builds up under this layer, it can press down on the kidney, causing a condition called Page kidney. However, the protective tissue around the kidney has a bit more space and can handle some more fluid or blood before the kidney is pressured.
Usually, Page kidney is caused by something external pressing down on the kidney. This can take a number of forms.
Sometimes, blood collecting around the kidney causes this. This can happen as a result from:
- Physical injuries – This could be from sports like football, hockey, or other contact sports. Injuries from car accidents, violence, or falling can also cause this.
- Medical procedures – Some medical procedures like a kidney biopsy, shockwave kidney stone treatment, surgery to the tube that carries urine from the kidney to the bladder, or a nerve block can cause this.
- Natural causes – Certain medications, abnormalities in the blood vessels, tumors, inflammation of blood vessels, or pancreatitis can cause this.
Other things might cause external pressure on the kidney, like collections of lymph fluid around a kidney transplant, a collection of urine outside the urinary tract, a type of tumor found near your kidneys, or large regular cysts.
The most common cause of Page kidney seems to be a buildup of blood under the kidney’s protective layer, caused by physical injuries or medical procedures. This was most frequently noticed after kidney biopsies, treatments to break up kidney stones, or other treatments like a ureteroscopy.
Other less common reasons for Page kidney include spontaneous bleeding in the kidney because of abnormal blood vessels, tumors, a cyst rupture, inflammation of blood vessels, or kidney inflammation. Collections of lymph fluid and fluid-filled sacs of urine have also been found. In some rare cases, we don’t know what causes Page kidney.
Risk Factors and Frequency for Page Kidney
Previous medical articles often depicted patients of kidney-related surgeries or procedures as young, fit male athletes with high blood pressure and a history of sports injuries. However, new data shows that these cases are now usually iatrogenic, which means they are inadvertently caused by a doctor’s care or procedure. These incidents are related to treatments involving the kidneys and can happen to anyone, regardless of age.
Signs and Symptoms of Page Kidney
Page kidney is a condition that can exhibit symptoms ranging from mild to severe. In severe cases, it could result in a medical crisis due to extremely high blood pressure. It’s important to remember that young people who have high blood pressure and show a kidney mass or have had abdominal injury could potentially have this condition. High blood pressure is the key sign of Page kidney and can appear quickly or slowly after the triggering event. Sometimes, the patient may not remember a trauma that could have caused it. If there has been recent bleeding around the kidney, a bruise on the side of the body may be visible.
The methods typically used to diagnose Page kidney include kidney ultrasound and computed tomography with contrast. In terms of kidney function, it is usually normal if only one kidney is compressed, since the other kidney can make up for it. However, if both kidneys are compressed or if a single functioning kidney (like in kidney transplants) is compressed, the kidney function may be affected.
Medical professionals need to remember that there could be a lengthy time period between the traumatic event and the emergence of high blood pressure. This time period could be anywhere from days to decades. The traumatic event might not even be noticed or remembered by the patient.
Testing for Page Kidney
The diagnosis for Page kidney, a condition where there’s a build-up of pressure around the kidney often caused by a bruise or hematoma, typically relies on imaging tests. The most common testing methods are ultrasound and CT (computed tomography) scan of the kidneys.
The benefits of using ultrasound is that it’s inexpensive, fast, easy to do, widely available, and it doesn’t involve any invasive procedures. However, it may not always detect small bruises or hematomas under the kidney capsule.
On the other hand, a CT scan is just as easy and non-invasive. It offers the added benefit of being more accurate in detecting small bruises or hematomas, and it’s often the preferred method for detecting a Page kidney.
Another possible test is the renal vein renin determination which can prove whether the Renin-Angiotensin-Aldosterone System (RAAS) – a hormone system that helps control blood pressure – is causing high blood pressure. However, this test is not often performed.
Treatment Options for Page Kidney
In the past, radical nephrectomy (complete removal of the kidney) or open surgery (a large incision in the body) were the main treatment methods for Page kidney. Today, however, there has been a shift towards a more conservative treatment plan thanks to advances in high blood pressure medications, particularly, those that fight against the renin-angiotensin-aldosterone system (RAAS), which regulates blood pressure and fluid balance in our body.
RAAS contributes to high blood pressure in cases of Page kidney, making medications that block RAAS an important part of the treatment plan. Medical treatment of high blood pressure might be needed for a short while if the cause of the kidney compression goes away on its own or after medical intervention. For example, this might occur after the body naturally absorbs or after the medical evacuation of a subcapsular hematoma (a collection of blood beneath the outer covering of the kidney)
A medical procedure may be needed in cases of larger, symptomatic, or enlarging collections (pooled areas of blood or other fluids), or when high blood pressure is hard to control. The main goals of these procedures are removing the hematoma causing pressure on the kidney and getting rid of a fibrocollagenous pseudocapsule (a thick layer of fibrous tissue), which can form in long-lasting cases. This might require open or percutaneous drainage of the pooled fluid. If the hematoma is long-standing, a fibrocollagenous shell may have formed, and removing this shell (decapsulation) or even total removal of the kidney (nephrectomy) may be required.
Recent case studies have shown that less invasive procedures, like laparoscopy (-a small incision and a special instrument are used) or radiology-assisted percutaneous drainage (a procedure where a thin needle is inserted into the body to remove the pooled fluid), can be effective alternatives. Percutaneous drainage seems to work better with hematomas that are less than three weeks old. However, more long-lasting hematomas often require more invasive procedures for adequate evacuation. In patients suffering from lymphangiomatosis (a condition where benign tumors grow in lymph system), the preferred management plan is percutaneous drainage combined with injection of sclerosing agents (medicines that help to shrink the growths).
In some cases, high blood pressure can be a long-term issue, and lifelong anti-hypertensive drug therapy might be needed. However, there isn’t a one-size-fits-all treatment plan for Page kidney. The appropriate management plan depends on various patient factors and the underlying condition causing the problem.
What else can Page Kidney be?
If a patient comes in with high blood pressure and you didn’t already know they had experienced a trauma in the side area, diagnosing a condition known as Page kidney would be pretty difficult. This is because Page kidney doesn’t really have any unique symptoms that would suggest its presence. The best way to spot this disease is through medical imaging procedures.
An increase in the level of a substance in the body known as ‘renin’, signals the activation of a system involved in blood pressure control named RAAS, and this may be caused by three possible conditions:
- Narrowing of the renal artery, also known as Renal Artery Stenosis.
- A kind of tumor found around the kidney’s filtration units called Juxtaglomerular Cell Tumor.
- A severe form of high blood pressure, referred to as Malignant Hypertension.
Other conditions that could be considered are
- Acute Rejection – which commonly happens after a kidney transplant.
- Acute Tubular Necrosis – a kidney disorder that damages the tube-like structures in the kidney.
- Renal Vein Thrombosis – a blood clot in a vein in the kidney.
What to expect with Page Kidney
The specific percentage of deaths or long-lasting health complications from this condition is not currently known. However, some cases may get better on their own without needing surgery. Often, the right medical treatment is needed and can be successful, because the issue might not resolve itself immediately, or possibly not at all.
Possible Complications When Diagnosed with Page Kidney
It’s vital to know some of the significant complications when caring for a patient with Page kidney. These include:
- Persistent high blood pressure
- Kidney failure
- Loss of a transplanted kidney
- Blood in urine
Preventing Page Kidney
Every surgery or medical procedure has potential risks, and Page kidney disease is no exception. The healthcare team should thoroughly explain to patients and their families the potential risks associated with kidney transplant surgery or a kidney biopsy. It’s crucial for patients who have developed Page kidney disease to understand that medication therapy could naturally resolve this complication. In some instances, though, surgery might be the best option. A kidney biopsy is a procedure that involves taking a small piece of kidney tissue for examination. The term “Page kidney” refers to a condition where the kidney is compressed, often caused by a build-up of pressure from a fluid collection or blood clot. This compression can lead to high blood pressure and kidney damage.
