Article

Bilateral renal hemorrhage due to polyarteritis nodosa wrongly attributed to blunt trauma.

Renal Unit, St Luke's Hospital, Bradford, UK.
Nature Reviews Urology (Impact Factor: 4.52). 10/2009; 6(10):563-7. DOI: 10.1038/nrurol.2009.180
Source: PubMed

ABSTRACT A 36-year-old, previously healthy man presented to an accident and emergency department with right-sided abdominal pain 7 days after he sustained a trauma to his right flank. He was using no medication other than over-the-counter analgesics since his injury.
Complete blood count, serum creatinine measurement, liver function tests, hepatitis B and C screening, abdominal CT, renal angiography, surgical exploration and histology of kidney samples.
Polyarteritis nodosa with Page kidney causing bilateral perirenal hematoma, severe hypertension and renal failure.
The patient was severely anemic, and his bleeding was investigated. A 15 x 13 x 12 cm retroperitoneal hematoma was found in the region of the right kidney and the patient underwent unilateral right nephrectomy. 3 weeks after discharge the patient was readmitted with a left-sided perirenal hematoma. Steel-coil embolization of the kidney stopped the bleeding but the patient developed hypertension and renal failure, and antihypertensive agents and dialysis were started. Microaneurysms and vessel-wall necrosis were discovered on re-examination of the angiogram and histology, respectively, so immunosuppressive therapy was started, comprising intravenous methylprednisolone daily for 3 days and oral prednisolone and intravenous cyclophosphamide for 4 weeks. Page kidney, resulting from the bleeding into the solitary kidney, caused stretching of the renal artery and deterioration of renal function, which required hemodialysis treatment.

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    ABSTRACT: INTRODUCCIÓN El riñón de Page supone un cuadro de constricción paren-quimatosa renal debida a un hematoma subcapsular o un gran hematoma perirrenal capaces de alterar la microcir-culación intrarrenal alterando el equilibrio hemodinámico y provocando fenómenos isquémicos que provocan la hiperplasia de las células yuxtaglomerulares aumentando así la cantidad de renina circulante y elevando las cifras de tensión arterial. El riñón de Page es una patología muy poco frecuente, registrándose poco más de un centenar de casos en la bibliografía médica desde su descripción en 1955. Con el paso de los años, la etiología de esta enfer-medad ha ido evolucionando debido al desarrollo de la medicina actual de tal manera que, en la era pretrasplan-te, los riñones de Page aparecían generalmente tras im-portantes traumatismos directos sobre la fosa renal. Actualmente la causa más frecuente de este tipo de hiper-tensión hiperreninémica es el hematoma subcapsular deri-vado de la biopsia renal en los pacientes después de la realización de un trasplante. Se presenta un caso de riñón de Page en este mismo contexto y se revisan los casos hasta el momento actual analizando la evolución de la etiología y el tratamiento.

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