非創傷性佩奇腎臟—案例報告與文獻回顧

蘇奕瑋、張東平、薛又仁、賴昱維、黃建榮、蕭毅君、李淑文、邱文祥

台北市立聯合醫院仁愛院區外科部泌尿科

Nontraumatic Page kidney– A case report and literature review

Yi-Wei Su, Tung-Ping Chang, Thomas Y. Hsueh, Yu-Wei Lai, Andy C. Huang, Yi-Chun Hsiao, Shu-Wen Li, Allen W. Chiu

Division of Urology, Department of Surgery, Taipei City Hospital Renai branch

Introduction:

Page kidney is a rare condition when blood accumulated at perinephric or subcapsular space and caused external compression of kidney. Most of the patient with Page kidney have the cause correlated with trauma. However, some may be iatrogenic or secondary to mass lesions. The symptoms include high renin related hypertension, impairment of renal function, hydronephrosis and renal ischemia. We presented a 48-year-old woman who had Page kidney caused by spontaneous renal subcapsular hemorrhage.

Case presentation: 

A 48-year-old woman with a history of old cerebral vascular accident (CVA), diabetes mellitus type II, hypertension and Grave's disease presented to emergency room (ER) with fever and tachycardia. Electrocardiography (EKG) disclosed Paroxysmal Supraventricular Tachycardia (PSVT) rhythm, and lab data showed hyperthyroidism, leukocytosis and pyuria. Aforementioned problem, thyroid storm and urosepsis were impressed and treated with PTU (propylthiouracil), beta blocker, and antibiotics with adequate hydration. As the heart rate was control, hypertension was found and anti-hypertensive agents with calcium channel blocker was added. Blood culture was compatible with urinary tract infection, but persisted fever and acute kidney injury were found under medication therapy. Therefore, further evaluation with abdominal CT (computed tomography) scan was arranged which revealed thick (8.8 x 2.2 cm) subcapsular hematoma of right kidney with pararenal space stranding and renal parenchyma ischemic change which were consistent with page kidney. There was no trauma, no abdominal or retroperitoneal procedure performed history and no cystic or tumor lesion noted. Hypertension with spontaneous renal subcapsular hemorrhage was considered. Ultrasound guide pig-tail drainage was performed, fever was subsided and kidney function improved after conservative treatment.

Conclusion:

        Even though Page kidney mostly happen in traumatic patients, we should always keep in mind when facing patient with high blood pressure and decreased renal function. The disease can be diagnosed via abdominal ultrasound, abdominal CT scan and Magnetic Resonance Image (MRI). Treatments include medical or surgical options depend on the severity and patient’s condition. Follow up on image and laboratory examination are crucial to evaluate the recovery of this circumstance.