What is the best course of action for a 40-year-old female patient with a complex medical history, including ectopic kidney, hypertension, hyperlipidemia, diabetes, gastroparesis, and anemia, who presents with new onset sharp and shooting pain after reaching under a car seat and feeling a pop, and is considering stopping lisinopril (angiotensin-converting enzyme inhibitor)?

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From the Guidelines

The patient should not stop taking lisinopril without consulting a healthcare provider, and her current symptoms of sharp and shooting pain after feeling a pop while reaching under a car seat require immediate medical evaluation, possibly in an emergency department, to rule out any serious conditions. The patient's complex medical history, including ectopic kidney, hypertension, hyperlipidemia, diabetes, gastroparesis, and anemia, necessitates careful consideration of her current symptoms and potential interactions with her medications. Given her history of hypertension and the potential risks associated with abrupt cessation of antihypertensive medication, such as rebound hypertension and cardiovascular complications, it is crucial that she continues her lisinopril until evaluated by a healthcare provider 1. The sudden onset of sharp, shooting pain accompanied by a popping sensation after reaching under a car seat could indicate a musculoskeletal injury, such as a muscle strain or tear, but could also suggest a more serious condition given her complex medical history. Some key points to consider in her management include:

  • Continuing her current medications, including lisinopril, until medically evaluated and advised to stop or change them.
  • Seeking immediate medical attention to assess her current symptoms and rule out any serious conditions that may require urgent intervention.
  • Considering pain management options that are safe given her medical history, such as acetaminophen, which may be preferable to NSAIDs due to her kidney condition and gastroparesis.
  • Ensuring that her diabetes, hypertension, and other chronic conditions are managed appropriately throughout this acute episode, with potential adjustments to her medications based on clinical findings.
  • If her pain is determined to be musculoskeletal, recommending physical therapy and appropriate pain management for recovery. It is also important to note that the patient's care involves multiple specialists, including gynecology, nephrology, endocrinology, orthopedics, and gastrointestinal specialists, indicating the complexity of her medical condition and the need for a comprehensive approach to her care.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Patient's Complex Medical History

The patient has a complex medical history, including:

  • Ectopic kidney
  • Hypertension
  • Hyperlipidemia
  • Diabetes
  • Gastroparesis
  • Anemia

Current Concerns

The patient's current concerns include:

  • Sharp and shooting pain after reaching under a car seat and feeling a pop
  • Nausea with activity, rated 5/10
  • Considering stopping lisinopril (angiotensin-converting enzyme inhibitor)

Relevant Studies

Studies have shown that:

  • An ectopic kidney can lead to complications such as hematuria and hydronephrosis, especially if associated with malrotation of the renal pelvis or calculus 2
  • Taking a comprehensive patient history is fundamental for accurate diagnosis and effective management of health conditions 3
  • Musculoskeletal disorders are a considerable concern in patients with chronic kidney disease, including those with end-stage kidney disease 4

Potential Course of Action

Based on the patient's complex medical history and current concerns, it is essential to:

  • Conduct a thorough physical assessment and take a comprehensive patient history to inform diagnosis and treatment 3
  • Consider the potential association between the patient's ectopic kidney and the new onset of sharp and shooting pain 2
  • Evaluate the patient's musculoskeletal symptoms and consider the potential for musculoskeletal disorders, such as osteoarthritis or chronic musculoskeletal pain syndrome 4
  • Discuss the risks and benefits of stopping lisinopril with the patient and consider alternative treatment options if necessary

Specialist Involvement

The patient is currently being managed by specialists in:

  • Gynecology
  • Nephrology
  • Endocrinology
  • Orthopedics
  • Gastroenterology It is crucial to coordinate care among these specialists to ensure comprehensive management of the patient's complex medical conditions.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Research

An Ectopic Pelvic Kidney.

Polish journal of radiology, 2015

3
Research

How to take a comprehensive patient history.

Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association, 2024

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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