In Page’s kidney, chronic, usually hematoma-related, pressure on the kidney area 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 the blood flow and, to some extent, the function of the kidneys.
What is a Page kidney?
Page’s kidney is a blood pressure disorder associated with compression of the kidneys and an increase in blood pressure. The phenomenon is named after its discoverer IH Page. He observed the connection in 1939 for the first time in an animal model. Back then, he wrapped the kidneys of his test 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. See gradinmath for What is Hypoxemia.
At that time, patients developed high blood pressure due to bleeding under the kidney capsule. A total of around 100 cases of Page’s kidney have been described to date. The phenomenon is therefore rather rare. Males, with a mean age of about 40 years, were most commonly affected. The changes in blood pressure resulted in an average measurable blood pressure of 177/95 mmHg. There was also increased serum renin in the veins of the kidneys.
Causes
Most commonly, a Page’s kidney is preceded by a bruise near the kidney capsule. Such a hematoma in the kidney area can be caused by medical measures or accidents. Rarely, a bruise occurs spontaneously in this area. This would be conceivable, for example, in patients whose coagulation disorders are impaired. Extremely rarely, urine in the surrounding tissues has been observed as the cause of Page’s kidney.
In individual cases, cystic and other masses near the kidneys were also responsible for the pressure on the kidneys. When pressure is constantly applied to the kidneys, blood flow decreases. This phenomenon is also known as an ischemic phenomenon associated with a hematoma.
Ischemia activates the renin-angiotensin-aldosterone system and, as a result, blood pressure rises. The causes of bleeding on the kidneys can be of various kinds. In the early phase of disease documentation, those affected were mostly athletes. The trigger for the kidney injury was usually a sports accident.
In the meantime, however, the safety measures within extreme sports have been strengthened. 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, Ailments & Signs
In the early stages, Page’s kidney may be accompanied by a slight pulling pain in the kidney area. This pain is related to the bruise and may subside over time. The resulting high blood pressure can cause morning headaches, nausea, nosebleeds and dizziness.
Shortness of breath, blurred vision, fatigue and insomnia may also be associated with arterial hypertension due to Page’s kidney. The patient often feels an increased urge to urinate. Under certain circumstances, however, Page’s kidneys remain asymptomatic or only trigger extremely non-specific symptoms.
Diagnosis & course of disease
The anamnesis, together with the determination of the blood pressure, can give the doctor a first indication of a possible Page’s kidney. Imaging procedures are essential to confirm the diagnosis. In particular, computed tomography clearly depicts the retroperitoneal space of the kidneys and makes bleeding recognizable.
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 trigger chronic kidney failure over time. In other cases, complete ischemia never occurs and renal failure is unlikely.
Complications
Due to Page’s kidney, those affected suffer from severe kidney problems and also from problems with blood circulation. First and foremost, 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 the entire body, which can significantly reduce and limit the quality of life of those affected.
It is not uncommon for the affected person to become irritable or to suffer from psychological problems and depression. Other unpleasant side effects are nausea, headaches and, not uncommonly, nosebleeds. Dizziness and vomiting can also occur through the Page kidney and make everyday life even more difficult. If there is no treatment, Page’s kidneys also lead to visual disturbances or insomnia.
Those affected themselves appear very exhausted and also suffer from shortness of breath. An increased urge to urinate can also occur due to illness. There are usually no complications associated with the treatment of Page’s kidney. A kidney transplant is only necessary in severe cases. Whether this will lead to a reduction in the life expectancy of the patient cannot generally be predicted universally.
When should you go to the doctor?
If kidney pain, swelling, and other signs of Page’s kidney occur, a doctor should be consulted. Kidney problems that cannot be traced back to a specific cause must be examined by a doctor. A doctor’s visit is also necessary if there are problems with the cardiovascular system or the gastrointestinal tract, since both can be the result of an advanced Page’s kidney. The family doctor can use the medical history to make an initial suspected diagnosis and refer the patient to a specialist in kidney disease.
People who have suffered an injury to the kidneys or the urinary tract are particularly likely to develop Page’s kidneys. Patients with kidney cysts or kidney hematomas also belong to the risk groups and should have the symptoms mentioned examined by a doctor. Page’s kidney is diagnosed and treated by a general practitioner or a nephrologist . Depending on the symptoms, other specialists for internal diseases can be consulted. Therapy for Page’s kidneys must be closely monitored by a doctor, as there is a risk of complications and side effects and interactions from prescribed medications.
Treatment & Therapy
In particular, if the causal bleeding in the kidney area was not far back, the doctor decides on conservative therapy for Page’s kidney. Preference is also given to conservative methods when the bleeding affects only extremely limited areas. The administration of ACE inhibitors is part of the standard therapy. The same applies to the supply of AT1 antagonists. The activity of the renin-angiotensin-aldosterone system is said to be down-regulated via these AT1 antagonists.
In addition, with a conservative form of therapy, the balancing of the liquid is initiated. When larger areas of the kidneys are affected by a hematoma, doctors usually use surgery to treat Page’s kidneys.
The same applies to hematoma formation that happened a long time ago or accompanying symptoms such as impaired kidney function. In such a case, percutaneous or endoscopic drainage of the bruises can drain the pressurizing fluid. In extreme cases, the affected kidney is surgically removed.
Outlook & Forecast
A Page kidney promises a relatively good prognosis. If the condition is treated early, inflammation and other medical complications can be avoided. The disease can stagnate for years and cause no symptoms. In other cases, kidney failure occurs, which is potentially life-threatening.
For the patient, a Page’s kidney has health consequences such as restricted physical performance and chronic pain. Furthermore, circulatory disorders and psychological complaints such as irritability and moodiness occur with a Page kidney. The side effects of kidney disease can severely limit the patient’s quality of life. There is still the prospect of a symptom-free life, as long as the condition is not very advanced and is treated comprehensively. Life expectancy is not reduced if the course is positive.
The prognosis of a Page’s kidney is made by a specialist in kidney and hypertension diseases. The nephrologist is usually responsible. The prognosis can change rapidly if the patient does not react optimally to the therapy or is severely restricted due to the side effects mentioned. Therefore, constant treatment is necessary, in which the prognosis is constantly adjusted. Conservative therapy is promising in the majority of cases. The prognosis must also be made in a specialist center for nephrology.
Prevention
As explained above, Page’s kidneys are a particular hazard for extreme athletes. Therefore, athletes should pay careful attention to adequate protection of the kidney area. Knowing about the phenomenon of Page’s kidney is itself a preventive measure. In the event of an inexplicable increase in blood pressure after accidents or biopsies, the patient may prick up their ears with this knowledge. This can result in an early diagnosis and thus a favorable course of the disease.
You can do that yourself
Page’s kidney can be relieved by changing diet or changing medications. People who suffer from kidney hypertension should first consult their doctor. The doctor will prescribe ACE inhibitors and AT1 antagonists and thereby already reduce the symptoms. The patient can supportively watch out for side effects and inform the doctor about any symptoms.
If severe kidney pain suddenly occurs, the medical emergency service will be contacted. Occasionally, a Page’s kidney requires surgical removal of the causative hematoma. Rest and bed rest apply after surgery. The patient should strictly follow the doctor’s instructions and not subject the kidneys to any further stress. The diet also needs to 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 an operation. Smokers should initially stop smoking until blood pressure has normalized.
If, despite all the measures, complications occur, a doctor’s visit is recommended. Page’s kidney can persist after surgery and must then be relieved by additional medication.
