Patients present with hypertension, which may be recognized acutely after an inciting event or following a delay 3. In the acute setting, patients may complain of flank pain. Reduced renal function may be noted.
Compression of the kidney results in compression of the intrarenal vessels, which leads to decreased blood flow to the renal parenchymal tissue and induction of renin secretion. Renin-angiotensin system activation results in hypertension.
Patients usually have an inciting event that leads to the development of a subcapsular collection, such as trauma or surgery. In some cases, spontaneous rupture of a mass, aneurysm, or cyst can be responsible 3.
All modalities will demonstrate a collection surrounding the kidney, of variable density/intensity/echogenicity depending on the nature of the collection. The collection is usually subcapsular in location, maintaining a reniform contour. Importantly, however, the adjacent renal parenchyma should be distorted.
On Doppler evaluation, renal arterial resistive index is elevated 4.
On contrast-enhanced examination, the affected kidney may demonstrate a delayed nephrogram.
History and etymology
This phenomenon was first described by Irvine H (Heinley) Page (1901-1991) 5,6 in 1939 2 when he discovered that hypertension could be produced in a dog by wrapping one or both kidneys in cellophane. Dr Page, was a renowned American cardiologist and is remembered for his research into hypertension, in particular his discovery of serotonin and his work on the renin-angiotensin system.
- 1. Chamorro HA, Forbes TW, Padkowsky GO et-al. Multiimaging approach in the diagnosis of Page kidney. AJR Am J Roentgenol. 1981;136 (3): 620-1. AJR Am J Roentgenol (citation) - Pubmed citation
- 2. Page, Irvine H. Journal of the American Medical Association. doi:10.1001/jama.1939.02800480032008
- 3. Dopson SJ, Jayakumar S, Velez JC. Page kidney as a rare cause of hypertension: case report and review of the literature. (2009) American journal of kidney diseases : the official journal of the National Kidney Foundation. 54 (2): 334-9. doi:10.1053/j.ajkd.2008.11.014 - Pubmed
- 4. Zvavanjanja RC, Ashton AS. Page kidney secondary to subcapsular hematoma following percutaneous renal allograft biopsy. (2018) Radiology case reports. 13 (3): 702-708. doi:10.1016/j.radcr.2018.03.016 - Pubmed
- 5. Frohlich ED, Dustan HP, Bumpus FM. Irvine H. Page: 1901-1991. The celebration of a leader. (1991) Hypertension (Dallas, Tex. : 1979). 18 (4): 443-5. Pubmed
- 6. Dustan HP. Irvine Heinly Page - January 7, 1901-June 10, 1991. (1995) Biographical memoirs. National Academy of Sciences (U.S.). 68: 237-50. Pubmed