Management of Page Kidney

Initial Assessment and Management

The American Urological Association recommends that initial management of Page kidney depends entirely on hemodynamic status: hemodynamically unstable patients require immediate surgical intervention or angioembolization, while stable patients should be managed conservatively with close monitoring and blood pressure control, reserving percutaneous drainage for cases with persistent hypertension or renal failure 1, 2
Assess for signs of hemodynamic instability including hypotension, tachycardia, or ongoing blood loss requiring transfusion, as recommended by the American College of Surgeons 1, 4
Obtain IV contrast-enhanced CT with immediate and delayed images to confirm diagnosis and assess for active bleeding, as suggested by the European Association of Urology 3, 4
Measure blood pressure, as Page kidney classically presents with severe hypertension due to external renal compression activating the renin-angiotensin-aldosterone system, according to the World Journal of Emergency Surgery 2
Check renal function (creatinine, eGFR) and electrolytes, particularly potassium, as recommended by the National Institute of Diabetes and Digestive and Kidney Diseases 5, 4

For hemodynamically unstable patients, immediate intervention is mandatory, and surgical exploration or angioembolization should be performed depending on institutional resources and expertise, as recommended by the American College of Surgeons 1, 2
Consider REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) as a temporizing bridge to definitive hemorrhage control in unstable patients, according to the World Journal of Emergency Surgery 2, 3
For hemodynamically stable patients, non-operative management is the standard of care, with intervention reserved for specific indications, such as persistent severe hypertension or renal insufficiency, as recommended by the European Association of Urology 1, 2, 3

Percutaneous drainage should be performed when medical management fails to control hypertension or when renal function deteriorates, as suggested by the American Urological Association 6, 2
Angioembolization is indicated for stable patients with evidence of ongoing arterial bleeding, such as arterial contrast extravasation on CT imaging, pseudoaneurysm formation, or arteriovenous fistula, according to the World Journal of Emergency Surgery 6, 2
Embolization should be performed as super-selectively as possible to preserve renal parenchyma, as recommended by the Society of Interventional Radiology 7, 6, 2

All patients require extended monitoring for development or persistence of hypertension, and monitor blood pressure periodically for up to one year after treatment, as recommended by the American Heart Association 2, 3
Perform follow-up CT imaging at 48 hours for high-grade injuries to assess for complications, as suggested by the American College of Radiology 1, 3
Check renal function recovery after intervention, and monitor for late complications including chronic hypertension requiring nephrectomy if medical management fails, according to the National Institute of Diabetes and Digestive and Kidney Diseases 2, 3