Spontaneous renal subcapsular hematoma associated with anticoagulation: A case of Page kidney with a favorable outcome under conservative management

Abstract

Renal subcapsular hematoma is an uncommon but potentially reversible cause of acute kidney injury and renin-mediated secondary hypertension, known as the Page kidney phenomenon. We report the case of a 74-year-old woman who presented with progressive worsening of blood pressure control over one month and several days of anuria. Her history was notable for long-standing hypertension, rivaroxaban therapy for more than two years, a recent fall, and probable nonsteroidal anti-inflammatory drug use. Laboratory evaluation revealed an elevated serum creatinine level of 158 μmol/L, corresponding to an estimated glomerular filtration rate (eGFR) of 27 mL/min/1.73 m². Contrast-enhanced computed tomography demonstrated a massive left renal subcapsular hematoma compressing the renal parenchyma, with a fat-containing lesion in the upper pole suggestive of ruptured angiomyolipoma. Although surgical intervention was recommended, the patient opted for conservative management with discontinuation of anticoagulation. During the three-month follow-up, the hematoma volume decreased by more than 50%, diuresis recovered, renal function stabilized (eGFR 30-35 mL/min/1.73 m²), and blood pressure control improved. This case highlights the importance of considering compressive renal lesions in anticoagulated elderly patients presenting with sudden deterioration of blood pressure control and reduced urine output.