Atraumatic Bilateral Page Kidney Treated With Laparoscopic Capsulectomy

Abstract

Page kidney refers to external compression of the renal parenchyma, typically due to a subcapsular or perinephric collection, leading to hypertension through activation of the renin–angiotensin–aldosterone system (RAAS). Although most cases occur following trauma or iatrogenic injury, spontaneous bilateral Page kidney is possible but extremely rare. We report the case of a 22-year-old male rugby player who presented with left hypochondrial and epigastric pain. Initial computed tomography demonstrated bilateral perinephric hematomas without evidence of renal rupture. Renal function was preserved, but the patient subsequently developed persistent hypertension. Imaging revealed bilateral perinephric collections causing significant renal compression with elevated resistive indices. Initial management included angiotensin receptor blockade and ultrasound-guided percutaneous drainage. However, fluid collections recurred, resulting in persistent renal compression and hypertension. The patient therefore underwent staged laparoscopic resection of the renal capsule. Intraoperatively, decompression of the kidneys resulted in visible improvement in renal perfusion and size. Postoperatively, blood pressure control improved with medical therapy. Bilateral Page kidney is a rare but potentially reversible cause of secondary hypertension. Early recognition is crucial. While medical management and percutaneous drainage may be effective in selected cases, recurrent collections may require definitive surgical decompression. Laparoscopic capsulectomy represents a safe and effective treatment option in refractory cases.