Page Kidney phenomenon following kidney transplant, secondary to acute postsurgical sub capsular hematoma compression: A case report

Page kidney is one of secondary arterial hypertension forms and it is due to external compression of renal parenchyma. Hematomas, masses or fluid collection, that lead to activation of the renin-angiotensin-aldosterone system, resulting in systemic hypertension and then renal failure are the main causes. Nowadays higher necessity of kidney transplants led to more frequent use of marginal grafts, exposed to major risk of primary non function, delayed graft function or acute post-surgical complications such as capsular detachment and following hematoma. Page effect must be suspected when we notice serum creatinine increase, diuresis contraction and arterial hypertension. Doppler ultrasound (DUS) could allow diagnosis but CT scan may detect even very small hematomas that require urgent surgical drainage in order to obtain rapid recovery of renal function. We present the case of a 61-year-old man, with end-stage renal failure secondary to focal glomerulosclerosis, who underwent kidney transplantation from a deceased heart beating expanded criteria donor in October 2015. On postoperative day thirteen we observed a rapid and severe increase of serum creatinine, and for this reason patient underwent surgery for hematoma evacuation. During the immediate postoperative time we observed a rapid decrease of serum creatinine until stabilization in post-operative day four.