Volume 50, Issue 1 Spring 2026 JVU 501-39 | Real-Time Ultrasound Detection of Post-Stenting Renal Hemorrhage Causing Transient Page Kidney Physiology-Real-Time Ultrasound Detection of Post-Stenting Renal Hemorrhage Causing Transient Page Kidney Physiology

Real-Time Ultrasound Detection of Post-Stenting Renal Hemorrhage Causing Transient Page Kidney Physiology

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This 2026 case report in the Journal for Vascular Ultrasound presents a rare complication of renal artery stenting—active renal arterial hemorrhage—detected in real time by duplex ultrasound. Renal artery stenting, used to treat significant atherosclerotic renal artery stenosis and associated resistant hypertension or declining renal function, carries a 10-14% peri-procedural complication risk, mostly vascular injuries. Hemorrhage post-stenting is considered uncommon and is typically diagnosed via computed tomography angiography (CTA) or digital subtraction angiography (DSA).<br /><br />The report details an 82-year-old male who underwent bilateral renal artery stenting for severe bilateral ostial stenoses. Hours later, he developed severe right flank pain, initial hypertension (systolic 200 mmHg), then hypotension after analgesia. Bedside duplex ultrasound uniquely identified active arterial bleeding from the right kidney’s upper pole extravasating into the perinephric space, confirmed subsequently by CTA showing ongoing hemorrhage with perinephric and retroperitoneal hematomas.<br /><br />Despite the hemorrhage being perinephric, the patient exhibited transient Page kidney physiology—secondary hypertension due to renal parenchymal compression and renin-angiotensin-aldosterone system (RAAS) activation—manifested as labile blood pressure and elevated intrarenal resistive indices (RI of 1.0). Hemoglobin dropped from 13.1 to 6.2 g/dL over two days. The patient was managed conservatively in the ICU without embolization.<br /><br />This case uniquely demonstrates duplex ultrasound’s capability to dynamically visualize active renal bleeding immediately post-stenting, ahead of confirmatory CTA. Ultrasound showed key signs including pulsatile extrarenal arterial jets, abnormal renal contour, echogenicity changes, and elevated resistive indices. The report underscores ultrasound’s potential as an immediate bedside tool for early detection of post-procedural bleeding, potentially expediting diagnosis and management compared to standard CTA or DSA.<br /><br />The hemorrhage was likely iatrogenic distal intrarenal arterial injury from wire or balloon manipulation during stenting. The report emphasizes the clinical significance of early recognition of flank pain and hemodynamic changes after renal interventions due to potential retroperitoneal hemorrhage, even when stents are patent. This pioneering documentation reinforces duplex ultrasound’s diagnostic value for vigilant post-stenting vascular surveillance and identification of rare yet serious complications like renal hemorrhage causing transient Page kidney physiology.

Keywords

renal artery stenting

active renal arterial hemorrhage

duplex ultrasound

atherosclerotic renal artery stenosis

resistant hypertension

computed tomography angiography

digital subtraction angiography

Page kidney physiology

intrarenal resistive indices

retroperitoneal hematoma