In Page’s kidney, chronic pressure on the kidney area, usually due to hematoma, triggers an increase in blood pressure. The formation of a hematoma in the kidney area is usually linked to an accident and, in the long term, restricts blood flow and, to some extent, kidney function.
What is a Page kidney?
Page kidney is a blood pressure disorder associated with compression of the kidneys and an increase in blood pressure. The phenomenon is named for its discoverer, I.H. Page. He first observed the connection in 1939 in an animal model. At that time, he wrapped the kidneys of his experimental animals in cellophane. This externally applied pressure on the kidney area triggered high blood pressure in the animals. The first observation in humans came about 15 years later. At that time, patients developed hypertension due to hemorrhage under the kidney capsule. In total, about 100 cases of Page’s kidney have been described to date. The phenomenon is therefore rather rare. Men with a mean age of about 40 years were most commonly affected. The changes in blood pressure resulted on average in a measurable blood pressure of 177/95 mmHg. Elevated serum renin was also present in renal veins.
Causes
Most commonly, Page’s kidney is preceded by a hematoma near the renal capsule. Such a hematoma in the kidney area may be due to medical procedures or accidents. Less frequently, a hematoma in this area also occurs spontaneously. This would be conceivable, for example, in patients whose coagulation is disturbed. Extremely rarely, urine in the surrounding tissue has been observed as a cause of Page’s kidney. Cystic and other space-occupying lesions near the kidneys have also been responsible for pressure on the kidneys in isolated cases. When sustained pressure is applied to the kidneys, decreased blood flow occurs. This phenomenon is also known as ischemic phenomenon in connection with hematoma. Ischemia activates the renin-angiotensin-aldosterone system and as a result, blood pressure increases. The causes of hemorrhage on the kidneys can be of various types. In the early phase of the disease documentation, the affected persons were mostly athletes. The trigger for the kidney injury was thus usually a sports accident. In the meantime, however, safety measures within extreme sports have increased. Sports accidents are therefore no longer the most common cause of a Page kidney. Instead, kidney biopsies and traffic accidents are now among the most important triggers of the phenomenon.
Symptoms, complaints, and signs
Page kidney may be accompanied by a mild pulling pain in the kidney area in its early stages. This pain is related to the bruise and may subside after some time. The resulting high blood pressure may cause morning headaches, nausea, nosebleeds and dizziness. Shortness of breath, visual disturbances, fatigue and insomnia may also be associated with arterial hypertension due to Page’s kidney. Often, the patient also experiences increased urination. However, Page’s kidney may remain asymptomatic or trigger only extremely nonspecific symptoms.
Diagnosis and course of the disease
The medical history, along with determination of blood pressure, may provide the physician with an initial clue to possible Page’s kidney. Imaging techniques are essential to confirm the diagnosis. In particular, computed tomography vividly depicts the retroperitoneal space of the kidneys and reveals hemorrhages. Depending on how severe the ischemia is and how early it is detected, the course of the disease differs. As a rule, the kidneys lose potassium as the disease progresses. Persistent pressure can promote additional inflammation and sometimes cause chronic kidney failure as the disease progresses. In other cases, complete ischemia never occurs and renal failure is not expected.
Complications
Due to Page’s kidney, affected individuals suffer from severe kidney discomfort and furthermore, circulatory discomfort. Primarily, however, this disease is associated with very severe pain in the kidneys. It is not uncommon for this pain to spread to the back or even to the entire body, which can significantly reduce and limit the quality of life of the affected person. It is not uncommon for the affected person to become irritable or suffer from psychological complaints and depression.Other unpleasant accompanying symptoms include nausea, headaches and not infrequently nosebleeds. Dizziness and vomiting can also occur as a result of Page’s kidney and continue to make everyday life more difficult. If not treated, Page’s kidney also leads to visual disturbances or insomnia. The affected persons themselves appear very fatigued and also suffer from shortness of breath. An increased urge to urinate can also occur due to the disease. The treatment of Page’s kidney does not usually lead to complications. Only in severe cases is a kidney transplant necessary. Whether this results in a reduction in the patient’s life expectancy cannot usually be universally predicted.
When should you see a doctor?
If kidney pain, swelling, and other signs of Page’s kidney occur, a doctor should be consulted. Kidney discomfort that cannot be attributed to a specific cause must be evaluated by a doctor. A visit to the doctor is also necessary if complaints of the cardiovascular system or the gastrointestinal tract occur, as both can be a consequence of advanced Page’s kidney. The general practitioner can make an initial tentative diagnosis based on the patient’s medical history and refer the patient to a specialist in kidney disease. People who have suffered an injury to the kidneys or urinary tract are particularly likely to develop Page’s kidney. Patients with renal cysts or renal hematomas are also at risk and should have said symptoms evaluated by a physician. Page’s kidney is diagnosed and treated by a general practitioner or a nephrologist. Depending on the symptoms, other specialists for internal diseases may be consulted. Therapy for Page’s kidney must be closely monitored by a physician because of the risk of complications and side effects and interactions from prescribed medications.
Treatment and therapy
Especially if the causative hemorrhage into the area of the kidneys is not far in the past, the physician opts for conservative therapy in Page’s kidney. Conservative methods are equally preferred when the hemorrhage involves only extremely limited areas. The administration of ACE inhibitors is part of the standard therapy. The same applies to the provision of AT1 antagonists. Via these AT1 antagonists, the activity of the renin-angiotensin-aldosterone system is to be down-regulated. In addition, if conservative therapy is used, fluid balancing is initiated. If larger areas of the kidneys are affected by a hematoma, the physician usually applies surgical measures to treat Page’s kidney. The same is true for longer-standing hematoma formation or associated symptoms such as impaired kidney function. Percutaneous or endoscopic drainage of the hematoma in such a case can drain the pressure-exerting fluid. In extreme cases, the affected kidney is surgically removed.
Outlook and prognosis
Page’s kidney promises a relatively good prognosis. If the condition is treated early, inflammation and other medical complications can be avoided. The disease may stagnate for years and cause no symptoms. In other cases, kidney failure occurs, which is potentially life-threatening. For the patient, Page’s kidney has health consequences such as impaired physical performance and chronic pain. Furthermore, Page’s kidney causes circulatory disorders and psychological complaints such as irritability and moodiness. The accompanying symptoms of kidney disease can severely restrict the patient’s quality of life. However, there is still the prospect of a symptom-free life, provided that the condition is not far advanced and is treated comprehensively. Life expectancy is not reduced if the disease progresses positively. The prognosis for Page’s kidney is determined by the specialist for kidney and high pressure diseases. The nephrologist is usually responsible. The prognosis can change rapidly if the patient does not respond optimally to therapy or is severely limited in health due to the aforementioned concomitant symptoms. Therefore, a constant treatment is necessary, in which the prognosis is adjusted again and again. Conservative therapy is promising in the majority of cases. The prognosis must also be made in a specialized center for nephrology.
Prevention
As explained above, Page’s kidneys are especially a hazard for extreme athletes. Therefore, athletes should conscientiously pay attention to adequate protection of the kidney area. Knowledge of the Page kidney phenomenon is itself a preventive measure. If there is an unexplained rise in blood pressure after accidents or biopsies, the patient may become alert with this knowledge. This may result in an early diagnosis and thus a favorable course of the disease.
What you can do yourself
Page kidney can be alleviated by changing the diet or changing medications. People who suffer from the kidney hypertension should first consult the doctor. The physician will prescribe ACE inhibitors and AT1 antagonists, already reducing the symptoms. The patient can supportively watch out for side effects and inform the doctor about any complaints. If there is a sudden onset of severe kidney pain, emergency medical services will be contacted. Occasionally, Page’s kidney requires surgical removal of the causative hematoma. After a surgical procedure, rest and bed rest apply. The patient should adhere strictly to the doctor’s instructions and not subject the kidneys to any further stress. The diet must also be changed. Foods that are particularly irritating or difficult to digest should be avoided. Alcohol and coffee should also not be consumed in the first few days after surgery. Smokers should initially stop consuming cigarettes until blood pressure has normalized. If complications occur despite all measures, a visit to the doctor is recommended. Page’s kidney may persist after surgery and must then be relieved by further administration of medication.
