Percutaneous renal denervation in the management of kidney-related pain syndromes: a case series.

Abstract

Introduction: Positive effects on pain reduction following renal denervation (RDN) have been described in patients with kidney-related pain syndromes, yet data on the safety and efficacy of redo RDN procedures are limited.

Methods: Consecutive patients with a history of chronic loin pain, hypertension and preserved renal function (eGFR ≥40 ml/min) scheduled for RDN were included. Changes in perceived pain, opioid and antihypertensive medication use, and blood pressure were prospectively assessed 3 months after each procedure.

Results: Two patients presented with a history of Autosomal Dominant Polycystic Kidney Disease (n = 2) and one with Loin Pain Hematuria Syndrome (n = 1). Two patients underwent a redo RDN. After the initial procedures, a reduction in perceived pain, along with a 50 % and 75 % reduction in the daily dosage of opioids, was observed in two patients. One patient showed no reduction in perceived pain or opioid use and underwent a redo procedure after 3 years, again with no reduction in perceived pain or opioid use. One patient who initially responded returned at 2 years with recurrent symptoms and underwent a redo procedure. After 3 months, a significant improvement in pain and opioid use was observed. Mean 24-hour systolic blood pressure decreased in all patients and after each procedure with a mean decrease of 12 mmHg. No adverse events were observed.

Conclusion: In hypertensive patients with kidney-related pain syndromes, percutaneous RDN may be considered as an alternative treatment option to reduce pain severity and improve blood pressure control. Redo procedures may be considered in patients with recurrent symptoms after an initial response.