Loin Pain Hematuria 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

Renal stone disease

Renal stone disease (urolithiasis, nephrolithiasis) covers many conditions causing kidney, ureteric or bladder stones. These include metabolic and inherited disorders, anatomical defects of the upper or lower urinary tract, and chronic urinary infection. However, most cases of renal stones are idiopathic. They present with loin or abdominal pain, and visible or non-visible haematuria; this is followed by the eventual passage of a stone and resolution, or the need for further investigation and intervention. Renal stones often recur, and it is important to identify the underlying cause, particularly because the risk can be related to diet and lifestyle, and is often associated with hypertension and/or diabetes mellitus. Although clinical management is largely surgical and can seem straightforward, the increasing prevalence of renal stone disease in developed countries is becoming a significant health and economic burden.

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.

632 A Rare Case of Genitourinary Tuberculosis Presenting as Occult Compensated Renal Failure

Abstract It is acknowledged in the literature that genitourinary TB is a diagnostic challenge due to its rarity and insidious presentation. We herein report a case of a 64-year-old gentleman originally from Peru with an unremarkable past medical history that attended his GP practice on multiple occasions complaining of recurrent left sided loin pain, headaches, and microscopic haematuria. Abdominal ultrasonography revealed an atrophic left kidney and dilated renal pelvis. This was interpreted to either be a complication of chronic renal calculi, or secondary to malignancy. Further investigations including CT urogram, MAG3 renogram, cystoscopy and anterograde pyelogram effectively ruled out malignancy, revealing hydronephrosis and loss of cortical thickness. And although this was initially dismissed, further deterioration prompted more robust investigations. A complication of testicular pain and swelling with an associated lack of response to prolonged courses of antibiotics and associated scrotal abscess on ultrasonography prompted rapid surgical decompression and drainage. Histopathological results reported findings of acute necrotising granulomatous inflammation with positive acid-fast bacilli on Ziehl-Neelsen staining – consistent with tuberculosis. Routine follow up since commencing anti-TB therapy showed marked improvement with no further episodes of haematuria or flank pain, and kidney function remained at baseline. By raising awareness of potential imaging features as well as more subtle clinical presentations, it is hoped that clinicians can consider genitourinary tuberculosis as a differential, if there is no improvement with conventional antimicrobial agents.

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.

Urinary Schistosomiasis in an Elderly Patient: The Ultrasonographic Findings and Case Report

Urinary schistosomiasis (US) causes chronic ill health and caused by the blood fluke Schistosoma haematobium. This disease is endemic in Africa and eastern Mediterranean countries, and has a predilection for the male gender. This is a 64-year-old farmer (swampy farming and fishing) for more than forty years, that was referred from a peripheral health care centre for abdominal and pelvic ultrasonography on account of abdominal pain and discomfort, bilateral loin pain, dysuria, and terminal hematuria for close to a year duration of onset. The ultrasonography demonstrated bladder wall thickening, mucosal thickening and polypoid proliferation in to the bladder lumen, irregular echogenic crust in the bladder base, suspended mobile echoes in urine most likely from hematoma and/or cystitis, there is associated mild-moderate biliterate dilatation of the pelvi-calyceal systems and ureters(hydroureteronephrosis). The remaining abdominal and pelvic organs appeared normal. Urinary parasitology demonstrated the ova of Schistosoma haematobium confirming the diagnosis of urinary schistosomiasis. We report the ultrasonographic features of urinary schistosomiasis because of its peculiar presentation and to emphasize importance of ultrasound in its assessment.

Conservative management of chylous leak after open radical nephrectomy in an adult patient: a case report and literature review

BackgroundChylous ascites is rare but still a recognized complication of retroperitoneal surgeries caused mostly by inadvertent trauma to lymphatic channels. In this article, we present a case report and literature review of adult patient, with malignant tumor of upper urinary tract, who developed chylous leak after open nephrectomy.Case presentationWe present a case of chylous leak for a 67-year-old female patient, presented to urology clinic with complaining of left loin pain and gross hematuria, found to have upper urinary tract tumor, she underwent open radical nephrectomy with lymph nodes dissection, and postoperatively she had chylous leak that is treated conservatively using octreotide and spironolactone without the need for total parenteral nutrition.ConclusionConservative management should always be the first choice of management of chylous leak and chylous ascites. Careful anatomical identification and securing of the periaortic lymphatics are needed to decrease the risk of postoperative chylous leak and ascites.

Exercise-induced Gross Hematuria due to Concurrent Nutcracker Syndrome and Immunoglobulin a Nephropathy

We describe a patient presenting with loin pain and recurrent exercise-induced hematuria who concurrently had immunoglobulin A (IgA) nephropathy and nutcracker syndrome. While the diagnosis of IgA nephropathy did not fully explain the clinical symptoms, initial computed tomography was unrevealing. Renal venography eventually confirmed the presence of nutcracker syndrome.

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.