SEVERE UNCONTROLLED HYPERTENSION FOLLOWING TRAUMATIC RENAL INJURY: PP.30.210

Abstract

Background: A 48-year-old man presented with severe left flank pain and haematuria, following slipping in the bath and falling hard on to his left side. On admission to the Emergency department he was hypertensive with a blood pressure (BP) of 205/91mmHg with a pulse rate of 45 beat per minute. Method and Results: Computed tomography (CT) scanning revealed a severe left renal injury with evidence of persistent bleeding, therefore the patient proceeded to laparotomy. Complete transection of the left kidney with massive surrounding haematoma was confirmed, requiring total nephrectomy. Throughout the operation his systolic BP was persistently above 200mmHg, despite aggressive pharmacological control akin to the management of surgical phaeochromocytoma patients. However when the renal artery was clamped the BP fell sharply to 90/30mmHg and temporary administration of noradrenaline was necessary. Conclusion: Systemic hypertension following kidney trauma was initially described by Erwin Page, hence the eponymous term Page kidney. It usually involves blunt trauma to the back or flank, leading to unilateral kidney damage. It is believed compression of the kidney parenchyma from renal capsule haematoma leads to hypoperfusion, and subsequent renin release and activation of the renin-angiotensin-aldosterone axis; resulting in systemic hypertension. Traditionally Page kidney has been treated with nephrectomy. In cases with a single functioning kidney, conservative management with fluid control and anti-hypertensives has been adequate, though chronic hypertension is a recognised long term complication. In certain cases resolution of hypertension occurred with surgical removal of the renal capsule and haematoma, with preservation of the kidney. There is also increasing use of radiological drainage of the haematoma. Page Kidney is a rare but potentially treatable cause of secondary hypertension, which can occur following a seemingly minor injury.