Saudi Journal of Kidney Diseases and Transplantation

CASE REPORT
Year
: 2011  |  Volume : 22  |  Issue : 5  |  Page : 1012--1013

Page kidney following renal allograft biopsy - Early recognition and treatment


Kamlesh Kumar Maurya, HS Bhat, Georgie Mathew, Ginil Kumar 
 Department of Urology, Amrita Institute of Medical Sciences and Research Centre, Kochi, India

Correspondence Address:
Kamlesh Kumar Maurya
Department of Urology, Amrita Institute of Medical Sciences and Research Centre, Pin Code: 682 026, Kochi, Kerala
India

Abstract

Ultrasound- guided percutaneous allograft renal biopsy is commonly done to evaluate graft dysfunction. Complications of renal biopsy are usually minor, and major complications occur only in less than 1% cases. We report a case of allograft renal biopsy which caused a subcapsular hematoma, Page kidney and deterioration of graft function. This was diagnosed by computed tomography (CT) scan, and early surgical intervention led to complete recovery.



How to cite this article:
Maurya KK, Bhat H S, Mathew G, Kumar G. Page kidney following renal allograft biopsy - Early recognition and treatment.Saudi J Kidney Dis Transpl 2011;22:1012-1013


How to cite this URL:
Maurya KK, Bhat H S, Mathew G, Kumar G. Page kidney following renal allograft biopsy - Early recognition and treatment. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2019 Oct 22 ];22:1012-1013
Available from: http://www.sjkdt.org/text.asp?2011/22/5/1012/84523


Full Text

 Introduction



Percutaneous allograft renal biopsy is a common procedure in post- transplant patients to evaluate parenchymal dysfunction. [1] These days, renal biopsy is carried out under ultrasound guidance using an automated spring- loaded biopsy device. Although generally considered safe, occasionally it is associated with complications. [2] Most of the complications are minor and are managed conservatively. The major complication is hematuria requiring blood transfusion, embolization or even surgical intervention. Subcapsular hematoma compressing the renal parenchyma and causing deterioration in renal function is rare. [3] We report a case of subcapsular hematoma causing Page kidney, which we could diagnose early. Prompt surgical intervention prevented the loss of graft kidney.

 Case Report



A 30- year- old male patient underwent a live related renal transplant. During the initial postoperative period, he had good urine output and serum creatinine came down to 1.2 g/dL. DTPA scan on the 5 th postoperative day showed good graft function with a glomerular filtration rate (GFR) of 31 mL/min. However, after about one week, the urine output started decreasing and serum creatinine increased to 3.4 mg/dL. Percutaneous allograft renal biopsy was done under ultrasound guidance to find the cause of renal dysfunction. During the post biopsy period, he developed hematuria and a drop in hemoglobin requiring blood transfusion. His urine output got decreased and his serum creatinine went up to 5.88 mg/dL. Evaluation with ultrasonography showed peri- graft collection. Computed tomography (CT) scan abdomen and pelvis revealed subcapsular hematoma compressing the kidney [Figure 1] and [Figure 2]. {Figure 1}{Figure 2}

Patient was stabilized and he underwent surgical exploration. Capsulotomy was done and hematoma with clots was evacuated. In the postoperative period, patient had progressive increase in urine output and his serum creatinine came down to 2 mg/dL. Early recognition and treatment of subcapsular hematoma could prevent the loss of graft. His renal biopsy was suggestive of Cyclosporin toxicity.

 Discussion



Percutaneous allograft renal biopsy is a standard procedure done to evaluate the cause of renal graft dysfunction or as part of protocol biopsy. [1] Renal biopsy has become much safer with the advancement of ultrasonography. These days, most of the biopsies are done under ultrasound guidance using an automated spring- loaded biopsy device.

Renal biopsy may be associated with complications. Literature reports of complications are in the range of 5-10%. [2],[3] Most frequent complications are microscopic hematuria and perirenal hematoma. [3] Most of the complications are minor. Major complications, requiring an invasive procedure such as blood transfusion, embolization or surgical intervention, account for less than 1%.

Page kidney phenomenon occurs as a consequence of external compression of the renal parenchyma, leading to decrease in renal blood flow, graft dysfunction and subsequently graft loss. A few cases of page kidney have been reported following allograft renal biopsy. [2] Usual presentation is oliguria following ultrasound guided biopsy, but the diagnosis may be missed due to pre- existing graft dysfunction for which the allograft renal biopsy was done. Ultrasound can diagnose perigraft collection; CT abdomen is helpful in confirming the diagnosis. Early recognition and immediate surgical decompression of the subcapsular hematoma can salvage the allograft.

References

1Figueroa TE, Frentz GD. Anuria secondary to percutaneous needle biopsy of a transplant kidney: A case report. J Urol 1988;140(2):355- 6.
2Rea R, Anderson K, Mitchell D, Harper S, Williams T. Subcapsular haematoma: A cause of post biopsy oliguria in renal allograft. Nephrol Dial Transplant 2000;15:1104- 5.
3Tuvell N, Sorrell K. Traumatic renal transplant subcapsular hematoma: Diagnosis by duplex ultrasound J Vasc Ultrasound 2005;29(1):39- 41.