Hi, I think renal complications may cause back pain. Renal complications are more particularly when you have a horse shoe kidney. Chances of urinary trat infections are much more with horse shoe kidney. This may cause a lower back pain. Any form of glomerular disease should also be ruled out, particularly because you have back pain, horseshoe kidney and hypertension. As you have a normal Xray and your orthopaedic consultant has excluded any bony abnormalities, musculoskeletal reasons seem less likely. However, mechanical back pain, particularly due to faulty posture during sitting or standing or prolonged sitting or lax abdominal muscles may not display any clinical sign or imaging abnormality. Thirdly, a colonic pain may present similarly. Irregular bowel habit may or may not be associated with this. A fourth common consideration is pelvic inflammatory disease or endometriosis or any uterine abnormality. For the time being, my recommendations are- 1. Urine for routine examination 2. USG lower abdomen including KUB 3. Plenty of oral fluid, preferably 3 lit per day. 4. Analgesia with tab paracetamol 500 mg twice daily. 5. Abdominal muscle strengthening exercise 6. Continue with antihypertensive medication and cardiac medications. Few more informations are needed regarding fever, bladder and bowel habit, pain abdomen for a more detailed answer. Regards, Dr. Kaushik