Page described hypertension associated with bleeding in and around the kidney.
Mechanism: compression of the kidney results in ischemia and renin release
Clinical features:
(1) There is a hematoma in the perinephric fat or beneath the renal capsule.
(2) The patient develops a new onset or significant worsening of arterial hypertension.
(3) The plasma renin is elevated.
(4) Removal of the hematoma results in reversal of the hypertension.
Causes for the hematoma may include:
(1) blunt or penetrating trauma
(2) renal biopsy
(3) vasculitis
(4) coagulopathy
Less often a mass compressing the kidney can cause the same findings.
Additional significance:
(1) The rise in blood pressure may mask hypotension secondary to blood loss with a massive hematoma.
(2) This may present as a pseudopheochromocytoma.
