Loin Pain Hematuria Syndrome Research Articles

Feasibility Study of a Randomized Controlled Trial Investigating Renal Denervation as a Possible Treatment Option in Patients with Loin Pain Hematuria Syndrome

Feasibility Study of a Randomized Controlled Trial Investigating Renal Denervation as a Possible Treatment Option in Patients with Loin Pain Hematuria Syndrome

Exome Sequencing in Patients with Loin Pain Hematuria Syndrome

Exome Sequencing in Patients with Loin Pain Hematuria Syndrome

473 Successful allotransplantation of donor kidney with loin pain hematuria syndrome (LPHS)

473 Successful allotransplantation of donor kidney with loin pain hematuria syndrome (LPHS)

Loin pain haematuria syndrome 1967-2020: a review.

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.

Laparoscopic renal denervation: A treatment option for management of refractory loin pain

Background: Intractable loin pain is a debilitating condition with a significant impact on the patient's quality of life. Loin pain haematuria syndrome (LPHS) is a disease of exclusion and can be of two subtypes, Primary or Type 2 and secondary or Type 1. The type 1 LPHS could be a result of congenital anomalies, or acquired due infections, trauma, or surgery. Management of these patients can be pharmacological, nerve blocks, renal denervation, auto-transplantation and nephrectomy. Laparoscopic renal denervation (LRDN) has emerged as a minimally invasive surgical procedure, with acceptable results. Materials and Methods: All patients who underwent laparoscopic renal denervation in our unit from 2007 to 2022 by a single surgeon were included in this study. The indications for surgical intervention were loin pain refractory to medical therapy in the absence of any physical causes of pain. All patients were assessed by a multidisciplinary team, involving a urologist, a nephrologist, a pain consultant, and a pain psychologist. Baseline and postoperative pain scores of the patients were obtained. The patients underwent splanchnic or coeliac nerve blocks under local anaesthesia and were reviewed in the outpatient clinic post-procedure. If there were an improvement in the pain control and pain scores, they were offered LRDN. During the surgery, the renal vessels and proximal ureter were stripped from the neuronal and lymphatic tissues. Results: The 20 patients included in the study underwent 23 procedures. All patients were female. The mean age was 44 years, and the median follow up was 24 months. The median operating time was 90 minutes, excluding anaesthetic time. There were no significant adverse events other than one patient needed antibiotics for chest infection. There was significant improvement of pain scores with the mean pain scores falling to 2.47 postoperatively from 8.40. Fifty percent of patients had complete resolution of pain, while 30% had significant reduction in use of pain medication. Patients with primary LPHS did not have significant improvement in their pain scores, and one of these patients required auto-transplantation of her kidney.

Decoding Loin Pain Hematuria Syndrome: In-Depth Review of Clinical Characteristics and Family History

Decoding Loin Pain Hematuria Syndrome: In-Depth Review of Clinical Characteristics and Family History

Robotic assisted kidney auto-transplantation as a safe alternative for treatment of nutcracker syndrome and loin pain haematuria syndrome: A case series report.

Describe the outcomes and safety of robotic-assisted kidney auto-transplantation (RAKAT) in the treatment of nutcracker syndrome (NCS) and loin pain haematuria syndrome (LPHS). This retrospective study included 32 cases of NCS and LPHS seen during December 2016 to June 2021. Three (9%) patients had LPHS and 29 (91%) NCS. All were non-Hispanic whites, and 31 (97%) women. The mean age was 32years (SD=10) and the BMI 22.8 (SD=5). The RAKAT was completed in all patients, 63% had a total improvement of pain. According to the Clavien-Dindo classification, 47% presented with type 1, and 9% with type 3 complications with a mean follow-up of 10.9months. The incidence of acute kidney injury in post-procedure was 28%. No one required blood transfusions, and there were no deaths during the follow-up. RAKAT was a feasible procedure with a similar complication rate to those reported for other surgical techniques.

Kidney Biopsy and Type IV Collagen Gene Sequencing Fail to Explain Hematuria in Loin Pain Hematuria Syndrome

Loin pain hematuria syndrome (LPHS) is a rare clinical syndrome with a reported prevalence of 1 in 10,000. The syndrome is characterized by severe pain localized to the kidney in the absence of identifiable urinary tract disease. Because of an inadequate understanding of the pathophysiology of the disease, the goal of management has been limited to symptomatic pain management. Through detailed phenotype and genotype assessment we sought to identify possible underlying etiologies. We completed a chart review, ultrasound imaging, kidney biopsy, and type IV collagen (COL4A3, COL4A4, and COL4A5) gene sequencing in 14 patients with loin pain hematuria recruited from a single center. Red blood cells and red cell casts were observed within the tubules in 10 of 14 patients. The glomerular basement membrane (GBM) was normal in 11 patients and thickened in 1 patient. Staining for IgA kappa was present in 1 patient. C3 deposition without any inflammation was present in 7 patients. Arteriolar hyalinosis was present in 4 patients and endothelial cell injury was present in 6 patients. No pathogenic COL4A3, COL4A4, or COL4A5 variants were identified. Conventional histopathology and genetic testing for type IV collagen variants failed to identify the cause of hematuria in 14 patients with LPHS.

Basic Research Protocol: Exome Sequencing in Adults With Loin Pain Hematuria Syndrome: A Pilot Study.

Loin pain hematuria syndrome (LPHS) is a poorly understood clinical syndrome characterized by hematuria and either unilateral or bilateral severe kidney pain in the absence of identifiable urological disease. Loin pain hematuria syndrome imposes a significant health and economic impact with a loss of productivity and quality of life in a young population. Owing to an incomplete understanding of its pathophysiology, treatment has been limited to nonspecific pain management. Nearly 60 years after its initial description, we are no further ahead in understanding the molecular pathways involved in LPHS. To outline the study design for exome sequencing in adults with LPHS and their families. In this single-center case series, 24 patients with LPHS and 2 additional first-degree family members per participant will be recruited. DNA extracted from venous blood samples will undergo exome sequencing on the Illumina NovaSeq 6000 System at 100× depth and will be assessed for pathogenic variants in genes associated with hematuria (number of genes in: glomerular endothelium [n = 10] and basement membrane [n = 8]), and pain pathways (number of genes in: pain transduction [n = 17], conduction [n = 8], synaptic transmission [n = 37], and modulation [n = 27]). We will further examine identified potentially pathogenic variants that co-segregate with LPHS features among affected families. This pilot study may identify new directions for an investigation into the molecular mechanisms underlying LPHS.

44 A Challenging Case of Loin Pain Hematuria Syndrome Resolved Post Renal Autotransplant

44 A Challenging Case of Loin Pain Hematuria Syndrome Resolved Post Renal Autotransplant

POS-543 DO RENAL BIOPSIES ASSIST IN UNDERSTANDING OF LOIN PAIN HEMATURIA SYNDROME?

Loin pain-hematuria syndrome (LPHS) first described in 1967, is a complex and poorly understood rare disease that predominantly affects young women. Patients with LPHS experience extreme flank pain along with hematuria in the absence of a primary kidney pathology. Due to inadequate understanding of the pathophysiology of LPHS, the goal of management has been limited to symptomatic relief and pain management. While it is uncertain if the source of pain and hematuria are interrelated, there is consensus that hematuria is glomerular in origin.

Open Notes and Closed-Loop Communication: A Case of Factitious Disorder in the Age of Transparent Medical Records

A 31-year-old woman with a nursing background and loin pain-hematuria syndrome undergoes a renal auto- transplant. During her recovery and prolonged hospitalization, her care team becomes increasingly concerned about a factitious disorder. With the roll-out of the 21^st Century Cures Act Final Rule, which involves direct sharing of medical records with patients in real time, multiple inpatient care teams leave their clinical suspicion out of their progress notes for fear of damaging the therapeutic relationship.

Loin Pain Hematuria Syndrome – A Case Report of a Challenging Diagnosis for Clinicians

Loin pain hematuria syndrome (LPHS) is a rare syndrome of loin pain associated with hematuria, which could be either gross or microscopic in nature. The condition causes severe discomfort for patients and can lead to many limitations in activities of daily life. As such, no primary kidney pathology has been associated with this syndrome which makes it a unique entity, to be diagnosed after exclusion of secondary causes of these symptoms. The symptom complex of Loin pain hematuria has been described classically presenting in young females in their third decade and is known to have spontaneous remissions in almost half of the patients, while as rest of the patients continue to have recurrent episodes of pain and hematuria. A high index of suspicion needs to be developed by treating physician in a patient with recurrent loin pain associated with/out hematuria. We present a patient with a similar clinical course where the diagnosis of LPHS was made on clinical grounds after excluding secondary causes of her symptoms.

Endovascular denervation (EDN): From Hypertension to Non-Hypertension Diseases

Recently, the use of endovascular denervation (EDN) to treat resistant hypertension has gained significant attention. In addition to reducing sympathetic activity, EDN might also have beneficial effects on pulmonary arterial hypertension, insulin resistance, chronic kidney disease, atrial fibrillation, heart failure, obstructive sleep apnea syndrome, loin pain hematuria syndrome, cancer pain and so on. In this article we will summarize the progress of EDN in clinical research.

Treatment and Management of Loin Pain Hematuria Syndrome

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. 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.

Update on Ghanem’s new scientific discoveries in physics, Physiology, and Medicine

Introduction and objective: To report the new scientific discoveries in physics, physiology and medicine by one author. Material and Methods: Results of my research are summarized. It is based on 2 clinical studies one prospective and the second case series on hyponatraemia (HN) of the transurethral resection of the prostate (TURP) syndrome. A physics study on porous orifice (G) tube proves Starling’s law is wrong. I reported prospective study on nephroptosis revealing its link with the loin pain haematuria syndrome (LPHS) and curative surgery for it. Results: Two physics and two physiological discoveries are reported. Acute HN presents as shock during surgery. It is induced by massive gain of sodium-free fluid recognized as volumetric overload shock (VOS). Features of the multiple organ dysfunction syndrome occur, include ARDS, Acute renal failure (ARF) and Coma. The prospective study demonstrated volumetric overload is the most significant in patho-aetiology. The case series demonstrated mistaking VOS for a known shock and treating it with further volume expansion cause death. Correct diagnoses as VOS and treating it with hypertonic sodium is lifesaving. The physics study on the G tube demonstrated that proximal, akin to arterial, pressure induces suction not filtration producing the hydrodynamic phenomenon that replaces Starling’s law. The link of LPHS with nephroptosis is demonstrated by the IVU 7 sign. The curative surgery for LPHS is renal sympathetic denervation and nephropexy. Conclusion: Dilution HN presents as shock that is mistaken for known shocks and treated with volume expansion causing death or ARDS. Manifestations include shock, ARDS, ARF and Coma. The correct treatment is hypertonic sodium. Starling s law has proved wrong. The correct replacement is the hydrodynamics of G tube. The puzzle of LPHS was also resolved.

Renal Auto-Transplantation for Loin Pain Hematuria Syndrome Using a Multidisciplinary Team Model: Intermediate-Term Results.

BackgroundPatients with loin pain hematuria syndrome (LPHS) can find relief via multiple modalities, few provide long-term pain control like renal auto-transplantation (RAT). This study evaluates the intermediate effectiveness of the RAT procedure’s ability to achieve long-term pain control and quality of life improvement.MethodsAll patients with suspected LPHS were seen by a multi-disciplinary team (MDT) composed of urologists, interventional radiologists, and transplant surgeons. Clinical history and physical exam, lab values, imaging findings, and response to renal hilar block (RHB) were used to determine LPHS and candidacy for potential RAT. Preoperative, one-year, three-year, and five-year postoperative pain assessment scores and quality of life surveys were administered to each LPHS and potential RAT patient.ResultsEighty-four LPHS patients were referred for the evaluation of and consultation for the option of RAT. Sixty-four of these patients underwent RHB of which 60 (93.8%) had a positive response, defined as a temporary reduction of pain score by >50%. Forty-six of the 60 patients who responded favorably proceeded to RAT. At the one-year follow-up, there was a 75% reduction in pain with 88.9% of patients experiencing a 50% reduction in pain. At one year, the mean Beck Depression Inventory (BDI) decreased by 65.4%, from an average of 23.7 to 8.2. Similarly, at three years (n = 5) and five years (n = 3), the mean pain scores were 2 and 1.ConclusionsThe MDT evaluation of potential LPHS patients with our protocol and treatment results in an improvement in pain and depression scores in these selected patients.

Interventional Approaches for Loin Pain Hematuria Syndrome and Kidney-Related Pain Syndromes.

Loin pain hematuria syndrome (LPHS) frequently presents with severe chronic pain that poses a clinical challenge. Current treatment approaches are mostly empirical and include a wide range of therapeutic strategies such as physical therapy, local and systemic analgesia, interventional and surgical approaches usually flanked by psycho-behavioral therapy, and other strategies. LPHS often impacts negatively on quality of life particularly in patients who are refractory to treatment. With recent advances in catheter-based treatment approaches and better understanding of the pathophysiology of LPHS, intraluminal renal denervation (RDN) has been proposed as a valuable treatment option for kidney-related pain syndromes. The present review provides a brief overview of the clinical challenges associated with LPHS, highlights recent insights into its underlying mechanisms, and summarizes currently available data on the use of RDN in the context of LPHS and kidney-related pain syndromes. Renal denervation via various approaches including surgical and catheter-based techniques has shown promise in alleviating kidney-related pain syndromes. Randomized controlled trials are now required to better define its role in the management of these conditions.

Update on Ghanem’s New Scientific Discoveries in physics, Physiology, and Medicine

Introduction and objective: To report the new scientific discoveries in physics, physiology and medicine by one author. Materials and methods: Results of my research are summarized. It is based on 2 clinical studies one prospective and the second case series on Hyponatraemia (HN) of The Transurethral Resection of the Prostate (TURP) syndrome. A physics study on porous orifice (G) tube proves Starling’s law is wrong. I reported prospective study on nephroptosis revealing its link with the Loin Pain Haematuria Syndrome (LPHS) and curative surgery for it. Results: Two physics and two physiological discoveries are reported. Acute HN presents as shock during surgery. It is induced by massive gain of sodium-free fluid recognized as Volumetric Overload Shock (VOS). Features of the multiple organ dysfunction syndrome occur, include ARDS, Acute Renal Failure (ARF) and Coma. The prospective study demonstrated volumetric overload is the most significant in patho-aetiology. The case series demonstrated mistaking VOS for a known shock and treating it with further volume expansion cause death. Correct diagnoses as VOS and treating it with hypertonic sodium are lifesaving. The physics study on the G tube demonstrated that proximal, akin to arterial, pressure induces suction not filtration producing the hydrodynamic phenomenon that replaces Starling’s law. The link of LPHS with nephroptosis is demonstrated by the IVU 7 sign. The curative surgery for LPHS is renal sympathetic denervation and nephropexy. Conclusion: Dilution HN presents as shock that is mistaken for known shocks and treated with volume expansion causing death or ARDS. Manifestations include shock, ARDS, ARF and Coma. The correct treatment is hypertonic sodium. Starling s law has proved wrong. The correct replacement is the hydrodynamics of G tube. The puzzle of LPHS was also resolved.

Pain Management Techniques for Loin Pain Hematuria Syndrome Case Report

Background: Loin pain hematuria syndrome (LPHS) is a rare syndrome presenting with chronic unilateral or bilateral flank pain and gross or microscopic hematuria. Case Report: We present a case of LPHS in a male with past medical history of atrial fibrillation, Barrett’s esophagus, and loin pain hematuria syndrome who initially presented to our medical facility with gross hematuria, intractable left flank pain, and non-bloody emesis. Our case exemplifies the challenge in managing patients with LPHS. Conclusion: Without a definitive mechanism for LPHS, current treatment focuses on symptom management. Analgesics (non-opioid and opioid) may be used orally or intravenous depending on the presence of concomitant nausea and vomiting. For patients at risk of opioid dependence, targeting afferent pain fibers originating from the kidneys and ureters has proven a successful analgesic strategy. Surgical options for renal denervation include: endovascular radiofrequency ablation, laparoscopic renal denervation, and renal auto transplant. Treatment options for this disease process include intra-ureteric bupivacaine, renal denervation, and possible spinal cord stimulation. Key words: Flank pain, loin pain hematuria syndrome, renal denervation, spinal cord stimulation