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Abstract: SA-PO859

Loin Pain and a New Mechanism: Altruistic Kidney Donation Is a Win-Win!

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Sriperumbuduri, Sriram, The University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Vaitla, Pradeep, The University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Anderson, Christopher, The University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Shafi, Tariq, The University of Mississippi Medical Center, Jackson, Mississippi, United States
Introduction

Loin pain due to complex reno-vascular anatomy can be debilitating. Refractory cases need auto transplantation and rarely nephrectomy to control the symptoms. Utilizing the nephrectomized kidney for donation is an option that is not commonly explored.

Case Description

A 40-year-old-female, non-hypertensive and non-diabetic, with persistent left flank pain for 4 years, sought help at our center for further management. Prior contrast computerized scan of the abdomen showed compression of left renal vein between aorta and vertebra concerning for nutcracker phenomenon. However direct measurement of venous pressures showed no significant pressure gradient aross the renal vein, raising concern for loin pain hematuria syndrome. Evaluation showed serum creatinine of 0.6 mg/dl and estimated glomerular filtration rate (eGFR) of 119 ml/min/1.73m2. Urine microscopy results over the past 4 years revealed no microscopic hematuria or significant proteinuria.

Due to unrelenting and episodic pain despite multiple medications, treatment options were offered including auto transplantation and nephrectomy. She was presented with the option of kidney donation if she chooses to proceed with nephrectomy. She agreed with directed kidney donation to an acquaintance and after appropriate work up, she underwent laparoscopic left kidney nephrectomy. Intraoperatively note made of 2 left renal veins terminating at angles into lumbar veins. The consensus was that it was the lumbar collateral that is retro-aortic and she had venous outflow obstruction from the kidney due to lack of collaterals formed from the lumbar veins. Her most recent serum creatinine was 0.98 mg/dl (eGFR 75 ml/min/1.73m2) about 4 months after the surgery and she remains flank-pain free.

Recipient of the kidney transplant is a 69-year-old caucasian male. He recovered well from the surgery with no symptoms of pain and hematuria. His nadir post-transplant creatinine was 1.2 mg/dL and eGFR of 55 ml/min/1.73m2 at 4 months.

Discussion

This case demonstrates the treatment options in cases with complex reno-vascular anatomy causing debilitating pain, including the unique possibility of donation of the kidney. Donation of healthy nephrectomized kidney is a unique display of altruism.