Page Kidney Phenomenon following Kidney Graft Biopsy: A Medical Emergency

Jackie Mak,Bulang He

doi:10.15344/2456-4443/2017/127

Abstract

Percutaneous kidney allograft biopsy is commonly used for either diagnostic purpose or as a protocol to identify subclinical pathology. It is a safe procedure with a low incidence of the major complication. Page kidney phenomenon is one of rare complication following the biopsy, which will need urgent surgical intervention. Two cases in our cohort developed Page kidney phenomenon following percutaneous kidney allograft biopsy under US guidance. One case presented to the emergency department 10 days after biopsy with increased pain over the kidney graft, whereas another case developed symptoms during the observation period immediate post the biopsy. Both patients underwent emergency surgical exploration and haematoma evacuation. In the former case, the kidney graft was lost due to extensive haemorrhagic necrosis of the kidney parenchyma, while in the latter case, the kidney graft was salvaged with satisfactory function over 3 years follow up. In conclusion, the Page kidney phenomenon can occur spontaneously, following kidney biopsy or trauma in the setting of kidney transplant. Doppler ultrasound is a very useful modality for the diagnosis. Prompt surgical exploration and evacuation of the haematoma is fundamental in order to salvage the kidney graft.

Highlights

Percutaneous renal allograft biopsy is commonly performed as a protocol or diagnostic biopsy after kidney transplantation to detect rejection, recurrence of kidney disease, infection and calcineurin inhibitor (CNI) nephrotoxicity [1]
Percutaneous renal biopsy has been increasingly used as a protocol biopsy after kidney transplantation
It is commonly performed to diagnose the underlying pathology when the renal function deteriorates. It is associated with some potential complications such as haematuria, urinary tract obstruction by clots, formation of pseudoaneurysm and/or arteriovenous fistula and perigraft or subcapsular haematoma

Summary

Introduction

Percutaneous renal allograft biopsy is commonly performed as a protocol or diagnostic biopsy after kidney transplantation to detect rejection, recurrence of kidney disease, infection and calcineurin inhibitor (CNI) nephrotoxicity [1]. There was no immediate post biopsy complication and her blood pressure remained stable at 140/80 mmHg during the observation period. The patient underwent urgent surgical exploration and evacuation of the subcapsular haematoma in the transplanted kidney.

Results

Conclusion