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Traumatic Page kidney: a systematic review and patient report of bilateral Gerota's fascia release
Anthony Onde Morada1, Amalie Kropp Lopez1, Andrew Droney1
1Geisinger Wyoming Valley Medical Center, Wilkes-Barre, Pennsylvania, USA.
Background:
Page kidney is a rare cause of secondary hypertension resulting from renal parenchymal compression by subcapsular hematoma. Although trauma represents a well-established etiology, comprehensive analysis of traumatic Page kidney remains limited. This systematic review consolidates current evidence on trauma-induced Page kidney and presents the first reported bilateral patient managed with surgical decompression.
Methods:
After PRISMA 2020 guidelines, we systematically searched PubMed, Embase, and Web of Science databases through March 2023 using "Page kidney" AND "trauma." Two independent reviewers screened 119 abstracts, including 24 studies meeting eligibility criteria. Data extraction included demographics, trauma mechanism, clinical presentation, imaging findings, treatment modalities, and outcomes. Additionally, we present a novel bilateral case requiring surgical intervention.
Results:
Twenty-four patients with traumatic Page kidney were analyzed (median age 24.5 years, 95.8% male). Blunt trauma predominated (50%), followed by falls (25%) and motor vehicle collisions (25%). Hypertension occurred in 87.5% of patients, with a median time to diagnosis of 15 days (range 0 year to 9 years). Left kidney involvement was most common (41.7%), with 16.7% occurring in renal allografts. Surgical decompression was performed in 37.5% of patients, percutaneous drainage in 25%, and nephrectomy in 20.8%. No mortality was reported. Our bilateral case involved a 54-year-old man who developed anuria after a motor vehicle collision, successfully treated with bilateral Gerota's fascia release.
Conclusions:
Traumatic Page kidney predominantly affects young men after blunt trauma, with frequent diagnostic delays. Surgical decompression achieves excellent outcomes when conservative management fails. Bilateral involvement is exceptionally rare but treatable with aggressive surgical intervention. Trauma surgeons should maintain clinical suspicion for Page kidney in patients with post-traumatic hypertension or unexplained renal dysfunction.
Level Of Evidence:
Level IV, therapeutic/care management.
