A Rare Case of Atraumatic Page Kidney in a Patient with EKRD

Introduction: Page kidney is a rare cause of secondary hypertension occurring due to renal parenchymal compression from subcapsular hematoma which induces renal microvascular ischemia and activation of the renin-angiotensin-aldosterone system. The major causes include trauma, iatrogenic, tumor, and vasculitis. Rarely, Page kidney can be caused due to anticoagulation use. We describe a rare case of atraumatic Page kidney in ESRD due to anticoagulation use leading to malignant hypertension. Case Description: A 60-year-old female with past medical history of ESRD, type 2 diabetes mellitus, hypertension, and CVA presented with fever, shortness of breath, and chest pain for 1 week. Patient denied abdominal pain and recent trauma. She was bedbound since having a CVA one month ago and was on heparin for DVT prophylaxis. On exam, patient was noted with elevated blood pressure 210/110 mm Hg. CT chest showed left lower lobe pneumonia with incidental finding of hematoma right kidney. Ultrasound of the kidney showed a large right renal subcapsular collection 12.5 x 6.9 x 8.0 cm with compression of the renal parenchyma suggestive of Page kidney with minimal vascular flow on color Doppler. CT abdomen showed similar findings with bilateral atrophic kidney. Labs were significant for WBC 19.8, Creatinine 5.7. Hemoglobin was 10.6 and was stable during hospital course. Blood pressure was controlled by starting antihypertensive medications, namely Amlodipine and Labetalol. Anticoagulation was held due to hematoma. Given stable hemodynamics, patient was conservatively managed with blood pressure control and renal function monitoring and was discharged with outpatient follow up for repeat renal ultrasound to ensure hematoma resolution. Discussion: Our case is unique as it is one of the first cases of Page kidney occurring in the setting of anticoagulation use in ESRD. Page kidney should be considered a possibility for malignant hypertension in the setting of anticoagulation use in ESRD.