residents’ room
Acute Page kidney immediately following blunt trauma to a solitary
pediatric kidney
Nicole Tuong; Michael Daugherty, MD; Jonathan Riddell, MD
SUNY Upstate Medical University, Syracuse, NY, U.S.
Cite as: Can Urol Assoc J 2016;10(5-6):E192-6. http://dx.doi.org/10.5489/cuaj.3395
Published online May 12, 2016.
a congenital atrophic right kidney (Fig. 1). On admission,
his blood pressure was 124/68 mmHg, pulse of 98, and
a respiration rate of 24. His hemoglobin was 11g/dL and
hematocrit was 35%.
Abstract
Page kidney refers to the occurrence of hypertension secondary to
renal compression and is usually associated with a subcapsular or
Hospital admission 1
perinephric hematoma. It generally occurs weeks to months after
In the emergency department, the patient received one unit
the initial injury. We report on a case of Page kidney occurring
of packed red blood cells (PRBC). A physical exam showed
acutely after Grade IV blunt renal trauma in a pediatric patient with
only abdominal tenderness and guarding. A focused assess-
a solitary kidney following a tobogganing accident. The child was
ment with sonography for trauma (FAST) exam was negative.
Repeat hemoglobin and hematocrit were 11g/dL and 33%,
respectively. He was hospitalized for six days, during which
his blood pressures ranged from 96‒134/43‒88 mmHg. His
hematocrit decreased to 22.3%, but stabilized at 26% on
discharge. His renal function and vital signs were stable
throughout the hospitalization.
initially managed conservatively and discharged after six days bed-
rest. He re-presented post-injury Day 12 with recurrent hematuria,
anemia, hypertension, and renal failure that required eventual, and
successful, surgical exploration.
Introduction
Pediatric renal trauma management guidelines are based
on the presence of two functioning kidneys and there is a
paucity of literature describing management of trauma to
a solitary kidney. Although expectant management is the
cornerstone of managing most blunt renal trauma, a solitary
kidney poses different challenges, as there is not a normal
contralateral unit to provide physiologic compensation — a
solitary Page kidney being one such example. While mul-
tiple guidelines state conservative management should be
tried first in patients with renal trauma, in a pediatric patient
with a solitary kidney, clinicians should have a low threshold
for radiologic or surgical management if kidney perfusion
and renal function start to decline.
Hospital admission 2
The patient re-presented to the emergency department six
days after discharge with with recurrent gross hematuria and
left upper-quadrant abdominal pain. He did not report any
additional trauma. His blood pressure was 145/80 mmHg
with a creatinine of 0.9 mg/dL (increased from a baseline
creatinine of 0.6 mg/dL), hematocrit of 23.5%, hemoglobin
8 g/dL, and a white blood cell count (WBC) of 18.9/uL. An
abdominal ultrasound showed the laceration to the lower
pole of the left kidney with decreased blood flow and an
organized hematoma (Fig. 2). There was also a large blood
clot seen in the patient’s bladder.
On the next hospital day, his hematocrit dropped to
2
1
0.2%, WBC increased to 21.9/uL, creatinine elevated to
.7mg/dL, and blood urea nitrogen (BUN) increased to 30
Case report
A nine-year-old boy presented to the emergency depart-
ment approximately eight hours after a tobogganing accident
with blunt abdominal trauma and dark urine. A computed
tomography (CT) scan of the abdomen and pelvis with and
without contrast showed a Grade IV left renal laceration
with associated left retroperitoneal hematoma, along with
mg/dL. He was transfused one unit of PRBC. A Doppler
ultrasound was repeated and showed an increasing large
heterogeneous, nonvascular collection surrounding his left
kidney involving the lower pole (Fig. 3). The left renal artery
had a peak systolic velocity was 135 cm/s at the aorta and
this increased to 523cm/s at the renal hilum (Figs. 4-5).
E192
CUAJ • May-June 2016 • Volume 10, Issues 5-6
2016 Canadian Urological Association
©
