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Annear NMP, Vanmassenhove J, Lameire N, Phillips ME, Eastwood JB. Loin pain haematuria syndrome 1967-2020: a review. Clin Kidney J 2024; 17:sfae034. [PMID: 38476400 PMCID: PMC10928983 DOI: 10.1093/ckj/sfae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Indexed: 03/14/2024] Open
Abstract
The purpose of this retrospective review is to question the validity of the condition 'loin pain haematuria syndrome' (LPHS). We highlight the possibility that most patients regarded as having LPHS have a psychiatric/psychological basis for their symptoms, particularly loin pain. Because of this, and because it recurs despite treatment, the review also questions the use of treatments that are invasive, expensive, and carry considerable morbidity.
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Affiliation(s)
- Nicholas M P Annear
- St George's, University of London, London, United Kingdom
- St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Norbert Lameire
- Department of Nephrology, University Hospital, Ghent, Belgium
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Zeb E, O'Connor A, Sabri S, Muhammad K, Qureshi N. Loin Pain Hematuria Syndrome-a case report. J Surg Case Rep 2021; 2021:rjab246. [PMID: 34804474 PMCID: PMC8598115 DOI: 10.1093/jscr/rjab246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 11/14/2022] Open
Abstract
Loin pain hematuria syndrome (LPHS) is a rare idiopathic condition. LPHS can present with both unilateral and bilateral loin pain, microscopic or macroscopic hematuria. It is a diagnosis of exclusion. The management options for this condition include pain management with narcotics or opioids, renal denervation, kidney autotransplantation and neurectomy or nephrectomy. However, these treatment modalities are the last resort.
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Affiliation(s)
- Ehtisham Zeb
- Department of General Surgery, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-Under-Lyne, United Kingdom
| | - Adam O'Connor
- Department of General Surgery, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-Under-Lyne, United Kingdom
| | - Shariq Sabri
- Department of General Surgery, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-Under-Lyne, United Kingdom
| | - Karim Muhammad
- Department of General Surgery, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-Under-Lyne, United Kingdom
| | - Nafees Qureshi
- Department of General Surgery, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-Under-Lyne, United Kingdom
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Urits I, Li N, Berger AA, Walker P, Wesp B, Zamarripa AM, An D, Cornett EM, Abd-Elsayed A, Kaye AD. Treatment and Management of Loin Pain Hematuria Syndrome. Curr Pain Headache Rep 2021; 25:6. [PMID: 33495883 DOI: 10.1007/s11916-020-00925-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW Loin pain hematuria syndrome (LPHS) is rare and seldom diagnosed, yet it has a particularly significant impact on those affected. This is a review of the latest and seminal evidence of the pathophysiology and diagnosis of LPHS and presents the typical clinical presentation and treatment options available. RECENT FINDINGS LPHS is typically found in young women with characteristic symptoms, including severe recurrent flank pain and gross or microscopic hematuria. The majority of patients will experience crippling pain for many years without effective therapy, often requiring frequent use of narcotic medication. However, the lack of conclusive pathophysiology, in conjunction with the rarity of LPHS, has prohibited the development and trial of definitive treatment options. Nevertheless, in order to combat this rare but severe disease, management strategies have continued to evolve, ranging from conservative measures to invasive procedures. This review presents an overview of the current hypotheses on the pathophysiology of LPHS in addition to summarizing the management strategies that have been utilized. Only 30% of LPHS patients will experience spontaneous resolution, whereas the majority will continue to face chronic, crippling pain. Several methods of treatment, including invasive and non-invasive, may provide an improved outcome to these patients. Treatment should be individually tailored and multi-disciplinary in nature. Further research is required to further elucidate the pathophysiology and develop new, specific, treatment options.
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Affiliation(s)
- Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.,Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Nathan Li
- Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Amnon A Berger
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Paul Walker
- Weill Cornell Medical College, New York, NY, USA
| | - Brendan Wesp
- Georgetown University School of Medicine, Washington, DC, USA
| | - Alec M Zamarripa
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Daniel An
- Georgetown University School of Medicine, Washington, DC, USA
| | - Elyse M Cornett
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
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Sollinger HW, Al-Qaoud T, Bath N, Redfield RR. The "UW-LPHS Test": A New Test to Predict the Outcome of Renal Autotransplant for Loin Pain Hematuria Syndrome. EXP CLIN TRANSPLANT 2018; 16:651-655. [PMID: 30251941 DOI: 10.6002/ect.2018.0236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The objectives of this pilot study were twofold. First, we aimed to elicit whether the "UW-LPHS test" definitively localizes pain from patients' loin pain hematuria syndrome to the ureter and thus proves our hypothesis. Second, we aimed to understand whether a positive UW-LPHS test predicts a successful outcome after renal autotransplant. MATERIALS AND METHODS The UW-LPHS test is described in detail in this manuscript. Briefly, 0.5% bupivacaine is injected into the ureter of the affected side and kept there using a balloon catheter for 5 minutes. RESULTS All six patients studied had complete pain relief at a mean follow-up of 9.2 months after renal autotransplant. All patients were successfully weaned from opioids and have returned to a normal lifestyle. CONCLUSIONS The UW-LPHS test can be used to predict renal autotransplant outcomes and should be applied to all patients who are being considered for this operation.
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Affiliation(s)
- Hans W Sollinger
- From the Division of Transplantation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Bath NM, Williams DH, Sollinger HW, Redfield RR. Commentary: Loin Pain Hematuria Syndrome. JOURNAL OF RARE DISEASES RESEARCH & TREATMENT 2018; 3:1-3. [PMID: 30984919 PMCID: PMC6457464 DOI: 10.29245/2572-9411/2018/4.1169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Loin Pain Hematuria Syndrome (LPHS) remains a rare disease but has a significant impact on those affected by it. Patients diagnosed with LPHS experience severe, constant or intermittent flank pain that radiates to the groin and may be exacerbated even by a gentle touch. These patients often require significant narcotic regimens for pain control and are unable to maintain a functional lifestyle. Previously, diagnosis has been made based on clinical presentation. One treatment for this syndrome is renal autotransplant; however, success rates are varied. Therefore, patient selection for this procedure is important. We have developed the UW-LPHS test as a diagnostic maneuver in order to determine which patients with LPHS would benefit from renal autotransplant. To perform this diagnostic test, bupivacaine is instilled into the ureter on the affected side and left to dwell. Patients who experience pain relief following this test are deemed to benefit from renal autotransplant. Here we describe this novel diagnostic test and initial success rates following renal autotransplant.
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Affiliation(s)
- Natalie M Bath
- Division of Transplant Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daniel H Williams
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Hans W Sollinger
- Division of Transplant Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Robert R Redfield
- Division of Transplant Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Prasad B, Giebel S, Garcia F, Goyal K, St Onge JR. Renal Denervation in Patients With Loin Pain Hematuria Syndrome. Am J Kidney Dis 2016; 69:156-159. [PMID: 27528372 DOI: 10.1053/j.ajkd.2016.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/29/2016] [Indexed: 11/11/2022]
Abstract
Loin pain hematuria syndrome (LPHS) is a painful and incapacitating condition that typically affects young women. Treatment options, including opiates and/or surgical denervation of the renal nerves by autotransplantation, have variable success. In this report, we describe the successful use of endovascular renal nerve ablation in this population. Four women with LPHS and intractable pain unresponsive to conservative measures underwent endovascular ablation of the renal nerves between July and November 2015 using the Vessix renal denervation system. The number and frequency of pain medications and responses to the EQ-5D, McGill Pain Questionnaire, Geriatric Depression Score, 36-Item Short-Form Health Survey, and Oswestry Disability Index were measured at baseline and 3 and 6 months postprocedure to evaluate changes in pain, disability, quality of life, and mood. There were improvements in pain, disability, and quality of life from baseline to 6 months postprocedure. By 6 months, 2 of 4 patients had discontinued all pain medications, whereas the other 2 had reduced their doses of these medications by 75%. These results suggest that percutaneous catheter-based renal nerve ablation with radiofrequency energy may be a treatment option for some patients with LPHS.
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Affiliation(s)
- Bhanu Prasad
- Section of Nephrology, Department of Medicine, Regina General Hospital, Regina, Canada.
| | - Shelley Giebel
- Section of Nephrology, Department of Medicine, Regina General Hospital, Regina, Canada
| | - Francisco Garcia
- Section of Nephrology, Department of Medicine, Regina General Hospital, Regina, Canada
| | - Kunal Goyal
- Section of Nephrology, Department of Medicine, Regina General Hospital, Regina, Canada
| | - Jennifer Rose St Onge
- Section of Nephrology, Department of Medicine, Regina General Hospital, Regina, Canada
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Zubair AS, Salameh H, Erickson SB, Prieto M. Loin pain hematuria syndrome. Clin Kidney J 2015; 9:128-34. [PMID: 26798473 PMCID: PMC4720203 DOI: 10.1093/ckj/sfv125] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 10/29/2015] [Indexed: 12/13/2022] Open
Abstract
Loin pain hematuria syndrome (LPHS), first described in 1967, is a rare pain syndrome, which is not well understood. The syndrome is characterized by severe intermittent or persistent flank pain, either unilateral or bilateral, associated with gross or microscopic hematuria. LPHS is a diagnosis of exclusion as there still is not a consensus of validated diagnostic criteria, though several criteria have been proposed. The wide differential diagnosis would suggest a meticulous yet specific diagnostic work-up depending on the individual clinical features and natural history. Several mechanisms regarding the pathophysiology of LPHS have been proposed but without pinpointing the actual causative etiology, the treatment remains symptomatic. Treatment modalities for LPHS are diverse including simple analgesia, opioid analgesic and kidney autotransplantation. This review article summarizes the current understanding regarding the pathophysiology of LPHS along with the steps required for proper diagnosis and a discussion of the different therapeutic approaches for LPHS.
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Affiliation(s)
- Adeel S Zubair
- Division of Transplantation Surgery, Department of Medicine , Mayo Clinic , Rochester, MN , USA
| | - Hassan Salameh
- Division of Nephrology and Hypertension, Department of Medicine , Mayo Clinic College of Medicine , Rochester, MN , USA
| | - Stephen B Erickson
- Division of Nephrology and Hypertension, Department of Medicine , Mayo Clinic College of Medicine , Rochester, MN , USA
| | - Mikel Prieto
- Division of Transplantation Surgery, Department of Medicine , Mayo Clinic , Rochester, MN , USA
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Taba Taba Vakili S, Alam T, Sollinger H. Loin Pain Hematuria Syndrome. Am J Kidney Dis 2014; 64:460-72. [DOI: 10.1053/j.ajkd.2014.01.439] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 01/17/2014] [Indexed: 11/11/2022]
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Bhandari A, Ellias M. Loin pain hematuria syndrome: Pain control with RFA to the splanchanic plexus. ACTA ACUST UNITED AC 2013. [DOI: 10.1163/156856900750233811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
The detection of blood in a child's urine is alarming and often prompts many laboratory studies. Hematuria is one of the most important signs of renal or bladder disease, but proteinuria often is a more important diagnostic and prognostic finding. The physician should ensure that serious conditions are not overlooked, avoid unnecessary laboratory studies, reassure the family, and provide guidelines for additional studies if there is a change in the child's course. This article provides an approach to the evaluation and management of hematuria in a child. Many tests have been recommended for the child with hematuria, but no consensus exists on a systematic evaluation.
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Affiliation(s)
- Kevin E C Meyers
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 34th Street and Civic Center Boulevard, Main Building, 2nd Floor, Philadelphia, PA 19104-4399, USA.
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Greenwell TJ, Peters JL, Neild GH, Shah PJR. The outcome of renal denervation for managing loin pain haematuria syndrome. BJU Int 2004; 93:818-21. [PMID: 15049996 DOI: 10.1111/j.1464-410x.2003.04724.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To 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 METHODS The 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. RESULTS Full data were available for 24 patients (13 women; median age 43 years, range 28-74) 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. CONCLUSIONS Renal 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.
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Affiliation(s)
- T J Greenwell
- Institute of Urology and Nephrology, 48 Riding House Street, London W1P 7PN, UK.
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