內視鏡腎囊腫造口術後之Page腎現象

高偉鈞、林才揚、黃冠華

台南永康奇美醫院 外科部 泌尿科

Page kidney phenomenon after endoscopic marsupialization of renal cyst

Wei-Chun Kao, Chye-Yang Lim, Steven K. Huang

Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan

Background: Page kidney, first described in animal experiments in 1939, was later recognized in humans during the 1950s and 1960s. Historically, the condition was most commonly associated with traumatic events, particularly sports-related injuries such as football trauma, as well as other forms of blunt renal injury. However, in recent decades, the etiology has shifted predominantly toward iatrogenic causes, especially following urologic or interventional procedures. The underlying pathophysiology involves external compression of the renal parenchyma, leading to renal hypoperfusion and ischemia, which subsequently activates the renin–angiotensin–aldosterone system (RAAS). This activation results in vasoconstriction and aldosterone-mediated sodium and water retention, ultimately contributing to secondary hypertension. Here, we present a case of a 63-year-old male who developed Page kidney following a postoperative course.

Case Presentation: A 63-year-old man with a history of hypertension, gout, and benign prostatic hyperplasia presented with left flank pain. Imaging revealed multiple left ureteral and renal stones, along with a 6.6 cm parapelvic renal cyst causing hydronephrosis. He underwent left retrograde intrarenal surgery (RIRS) with JJ stent placement. After stent removal, the patient developed recurrent fever, chills, dysuria, and flank pain, with laboratory and imaging findings consistent with recurrent pyelonephritis, and persistent hydronephrosis. Despite antibiotic therapy, symptoms persisted, requiring percutaneous nephrostomy (PCN) drainage followed by ureteroscopic lithotripsy, repeat RIRS, and cyst marsupialization. He subsequently developed fever and left flank swelling. Imaging demonstrated a perirenal and subcapsular hematoma compressing the renal parenchyma, accompanied by acute kidney injury and hypertension, consistent with Page kidney phenomenon. Percutaneous pigtail drainage was performed, yielding approximately 850 mL of purulent fluid growing Enterococcus faecalis. The patient improved with drainage and antibiotics, and long-term follow-up computed tomography (CT) urography confirmed resolution without recurrence.

Conclusion: Page kidney should be considered in patients presenting with new-onset hypertension accompanied by flank pain. The diagnosis is typically established through imaging modalities, including renal ultrasonography and CT. Initial management is primarily conservative, focusing on oral antihypertensive therapy, particularly with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) targeting the RAAS. In cases of persistent uncontrolled hypertension or progressive deterioration of renal function, invasive interventions such as percutaneous or surgical drainage of the compressive hematoma may be required.