Hori Shunta, Tomizawa Mitsuru, Maesaka Fumisato, Owari Takuya, Morizawa Yosuke, Nakai Yasushi, Miyake Makito, Yoneda Tatsuo, Tanaka Nobumichi, Yoshida Katsunori, Fujimoto Kiyohide
Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
BMC Nephrol. 2018 Mar 13;19(1):59. doi: 10.1186/s12882-018-0860-2.
Page kidney phenomenon is caused by strong renal parenchymal compression and leads to renal hypoperfusion and microvascular ischemia, resulting in renal dysfunction and hypertension. Although the development of Page kidney phenomenon in allograft is rare, most of its cases are induced by allograft biopsy or trauma. We observed a case of Page kidney phenomenon that was induced by unusual causes immediately after kidney transplantation.
A 66-year-old man, whose wife donated a kidney, underwent ABO-compatible living kidney transplantation. The allograft had three renal arteries that were trimmed and formed into one piece on the back table, and subsequently, it was anastomosed to the internal iliac artery. Intraoperative Doppler ultrasonography (US) revealed adequate blood flow of each renal artery. Urine output was also observed as soon as allograft blood flow was reperfused. After the surgery, the urine output decreased, and serum creatinine level increased to 6.0 mg/dL. Doppler US did not show evidence of acute rejection, ureteral obstruction, or anastomotic stenosis of the renal arteries. On postoperative day 7, surgical exploration was performed and revealed that the blood flow of each renal artery was adequate but subcapsular hematoma was detected at the upper pole of the allograft. Capsulotomy and hematoma evacuation were performed. Subsequently, urine output increased and serum creatinine level decreased up to 1.7 mg/dL. Allograft sample was obtained 1 h after the transplantation from the lower pole of the allograft. Although the cause of subcapsular bleeding was unclear in this case, a small cyst of the allograft, which might have ruptured during donor nephrectomy, was located in the middle of the hematoma, and oozing around the cyst was observed.
Our case indicated that the small ruptured cyst of the allograft could be the cause of subcapsular hematoma and Page kidney phenomenon. Subcapsular hematoma caused by oozing over time could be difficult to diagnose using Doppler US, and thus, other imaging modalities, such as computed tomography, should be considered. Knowledge of the Page kidney phenomenon in the allograft can lead to early diagnosis and intervention, resulting in better outcomes for recipients with allograft dysfunction.
佩奇肾现象由强烈的肾实质压迫引起，导致肾灌注不足和微血管缺血，进而引发肾功能障碍和高血压。尽管同种异体移植中佩奇肾现象的发生较为罕见，但其大多数病例是由同种异体移植活检或创伤诱发的。我们观察到一例肾移植术后立即由不寻常原因诱发的佩奇肾现象。
一名66岁男性接受了ABO血型相合的活体肾移植，供体为其妻子。移植肾有三条肾动脉，在手术台上修剪并合并为一条，随后与髂内动脉进行吻合。术中多普勒超声检查显示每条肾动脉血流充足。移植肾血流再灌注后立即观察到尿量。术后，尿量减少，血清肌酐水平升至6.0mg/dL。多普勒超声未显示急性排斥反应、输尿管梗阻或肾动脉吻合口狭窄的迹象。术后第7天进行手术探查，发现每条肾动脉血流充足，但在移植肾上极检测到包膜下血肿。进行了包膜切开和血肿清除术。随后，尿量增加，血清肌酐水平降至1.7mg/dL。移植后1小时从移植肾下极获取了移植肾样本。尽管该病例中包膜下出血的原因尚不清楚，但在血肿中间发现了一个移植肾小囊肿，可能在供肾切除术中破裂，且囊肿周围有渗血。
我们的病例表明，移植肾小破裂囊肿可能是包膜下血肿和佩奇肾现象的原因。随着时间推移，由渗血引起的包膜下血肿可能难以通过多普勒超声诊断，因此应考虑其他成像方式，如计算机断层扫描。了解同种异体移植中的佩奇肾现象可实现早期诊断和干预，从而为移植肾功能障碍的受者带来更好的结果。
