SHM Converge Scientific Abstract ePoster Gallery-Unmasking Page Kidney: Tackling Secondary Hypertension With a Multidisciplinary Approach

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This case report describes <strong>Page kidney</strong>, a rare but reversible cause of <strong>secondary hypertension</strong> due to <strong>external compression of the kidney</strong>, which triggers renal ischemia and activates the <strong>RAAS system</strong>, leading to severe blood pressure elevation.

A <strong>47-year-old woman</strong> with known hypertension presented with <strong>dyspnea, leg swelling, and hypertensive emergency</strong> (BP 219/147). She had been <strong>nonadherent to antihypertensive medications because of cost</strong> and was also found to have <strong>new heart failure</strong>. Workup showed elevated creatinine, BNP, mild hypercalcemia, anemia, and imaging abnormalities including a <strong>large pancreatic pseudocyst</strong> and possible renal involvement. Echocardiogram demonstrated <strong>reduced ejection fraction (40%)</strong>, severe left ventricular hypertrophy, and elevated pulmonary pressures.

Renal ultrasound showed <strong>no renal artery stenosis</strong>, but did reveal <strong>absent Doppler flow to the left kidney</strong> and abnormal renal tissue, raising concern for Page kidney. Nephrology recommended <strong>interventional radiology drainage of the pancreatic pseudocyst</strong>, after which the patient’s <strong>blood pressure normalized</strong> and she was discharged.

The discussion emphasizes that <strong>secondary hypertension in middle-aged patients requires evaluation for causes such as hyperaldosteronism, obstructive sleep apnea, and renal artery stenosis</strong>, with tests including BMP, urinalysis, aldosterone/renin ratio, and polysomnography. Page kidney is usually diagnosed by <strong>renal ultrasound</strong>, though CT may be useful if ultrasound misses smaller hematomas or compressive lesions.

Treatment focuses on <strong>blood pressure control and relief of the compressive cause</strong>, often with <strong>RAAS-blocking agents</strong> if conservative management is needed. This case highlights the importance of <strong>prompt multidisciplinary evaluation and intervention</strong>, since untreated Page kidney can lead to <strong>renal failure</strong>.

Asset Subtitle

Avery A. Green

Meta Tag

Author List Aaron Byczynski, Avery A. Green, Pinky Jha

Category Clinical Vignettes

Concept Page Kidney

Concept Renal Compression

Concept Kidney Ischemia

Concept Renin-Angiotensin-Aldosterone System Blockade

Concept Secondary Hypertension

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Avery A. Green

Track Adult

Keywords

Page kidney

secondary hypertension

renal compression

RAAS activation

hypertensive emergency

pancreatic pseudocyst

renal ischemia

renal ultrasound

blood pressure control

interventional drainage

Page Kidney

Renal Compression

Kidney Ischemia

Renin-Angiotensin-Aldosterone System Blockade

Secondary Hypertension