The outcome of renal denervation for managing loin pain haematuria syndrome

Abstract

having 33 denervations (eight bilateral and one repeat) with a median follow-up of 39.5 months. Most patients had no identifiable underlying cause although many had initially been diagnosed as having stone disease (42%) or pyelonephritis (25%), but with no corroborative evidence. All patients had been extensively investigated and had normal urine samples and cytology, and no abnormality on intravenous urography, renal tract ultrasonography and isotopic renography. Twenty-four renal denervations (73%) were followed by recurrent ipsilateral pain at a median (range) of 11 (0-120) months after surgery. Nine denervations (25%) in six men and two women were curative (median follow-up 16.5 months). Of those with recurrent pain, nine (38%) proceeded to nephrectomy, of whom three then developed loin pain on the contralateral side and two developed disabling wound pain. The analgesic requirement was less after eight non-curative denervations. There were no significant postoperative complications. CONCLUSIONSRenal denervation has only a 25% success rate for managing pain associated with LPHS and should be used cautiously for this indication. Men had more benefit from the treatment; a third of patients had less requirement for analgesic after non-curative denervation. KEYWORDSrenal denervation, sympathectomy, loin pain haematuria syndrome, chronic pain OBJECTIVETo evaluate the outcome of renal denervation for the treatment of loin pain-haematuria syndrome (LPHS), a rare syndrome of unknown cause associated with debilitating and intractable loin pain. PATIENTS AND METHODSThe case notes of 32 patients having 41 renal denervations were reviewed. Data collected included patient demographics, possible causes, cure or not after renal denervation, time to recurrence of pain after denervation and further operative intervention for managing LPHS. RESULTSFull data were available for 24 patients (13 women; median age 43 years, range

Evaluation and Management of Pain in Autosomal Dominant Polycystic Kidney Disease

“…The complete removal, using sharp dissection, monopolar or bipolar electrocautery, or ultrasonic dissection is necessary to prevent re-nervation and accounts for poor long-term results of this procedure for other indications. 59,60 Although Chapuis and colleagues 58 reported a unilateral procedure, they suggested that a bilateral thoracoscopic approach could be performed in 1 procedure. Recently, another small series reported 4 adolescent ADPKD patients who underwent laparoscopic denervation of 5 kidneys by abdominal transperitoneal approach, with excellent intermediate results.…”

Ureteric bupivicaine infusion for loin pain haematuria syndrome

“…2 The efficacies of these highly invasive procedures are variable. Greenwell et al 4 reported a modest 25% success rate in a study of 32 patients with chronic loin pain who underwent renal denervation. Chin et al, 9 in their 26-patient study of renal autotransplantation, recorded pain reduction in 69% of patients at follow-up; six cases, however, required nephrectomy due to complications such as ischaemia and renal vein thrombosis at surgery.…”

“…4,5 The age of onset can vary between the first to sixth decades of life, but the majority develop symptoms in the third decade. 2 An association between LPHS and psychiatric symptoms was reported in early cases.…”

Bilateral Renal Autotransplantation May Be an Effective and Definitive Treatment in Case of Loin Pain Haematuria Syndrome

“…Moreover, frequent secondary effects associated with these therapies ranged from mild to severe, with cases of nephrectomy after capsaicin injection reported or subsequent dependency on opiates. Also, using more invasive methods as nerve blockade or selective renal denervation, results were disappointing [7] .…”