Page kidney

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The Page-kidney is a secondary form of high blood pressure that is based on pressure ( compression ) on the kidneys from outside through an acute or chronic disease process.

The Page kidney was first described in an animal model in 1939 by Irvine H. Page. Page could cause high blood pressure in experimental animals if he wrapped the animals' kidneys in cellophane . The disease was first observed in humans in 1955, in a patient who developed high blood pressure after bleeding under the kidney capsule .

causes

In most cases, a Page kidney is caused by a bruise under the kidney capsule (subcapsular hematoma ) or in the immediate vicinity of the kidney (perinephric hematoma). The bleeding can be caused by an accident ( traumatic ) or by medical measures such as B. be triggered by a kidney biopsy or a kidney stone fragmentation ( iatrogenic ) or occur spontaneously (e.g. in blood clotting disorders). In rarer cases, leakage of urine into the tissue ( urinoma ), large kidney cysts, or space- occupying processes in the vicinity of the kidney can lead to a Page kidney.

Pathogenesis

The compression of the kidney leads to a reduction in blood flow to the kidneys ( ischemia ), which in turn activates the renin-angiotensin-aldosterone system . The activated renin-angiotensin-aldosterone system results in an increase in blood pressure and a loss of potassium via the kidneys, which can lead to a decrease in the potassium level in the blood ( hypokalaemia ). In addition, compression of the kidneys can lead to inflammation of the intermediate tissue ( interstitial nephritis ). As the disease progresses, the kidney concerned may lose its function . A chronic renal failure is prevented by the remaining kidney function is not affected.

Epidemiology

Over 100 cases have now been described in the literature. Two thirds of those affected are men between the ages of 17 and 69 (mean age 38 years). The mean blood pressure at diagnosis was 177/95  mmHg . Renin was measured in the renal veins in only eight patients, and in all cases there was an increased renin level in the vein of the affected kidney. In older reports, most cases were described in young male athletes after sports accidents. The high blood pressure was often not diagnosed until years after the accident. In more recent reports, car accidents and kidney biopsies are the top causes of a Page kidney. Improved protective measures in high-risk sports may have contributed to a decrease in sport-related kidney injuries.

Diagnosis

The diagnosis of the Page kidney is usually carried out using imaging methods , in particular computer tomography , which, compared to sonography, provides more precise results and allows a better representation of the retroperitoneal space.

therapy

Conservative therapy

For fresh, smaller hematomas, a conservative attempt at treatment can be undertaken with fluid balancing and drug therapy with ACE inhibitors and AT1 antagonists ; these are substances that inhibit the renin-angiotensin-aldosterone system.

Operative therapy

Surgical therapy may be necessary if the hematoma is large or persistent, or if renal function deteriorates. The hematoma can be drained percutaneously or endoscopically . In complex situations, open relief of the hematoma or even surgical removal of the affected kidney ( nephrectomy ) may be necessary.

literature

Web links

Individual evidence

  1. ↑ Irvine H. Page: The production of persistent arterial hypertension by cellophane perinephritis . In: Journal of the American Medical Association . 113, No. 23, December 2, 1939, pp. 2046-2048. doi : 10.1001 / jama.1939.02800480032008 .