Loin Pain Hematuria Syndrome

Clinical and safety outcomes of laparoscopic nephrectomy with renal autotransplantation for the loin pain‐hematuria syndrome: a 14‐year longitudinal cohort study

“…However, this is currently limited by a rare clinical entity of LPHS. In response to excessive incidence of recurrent pain in LPHS patients undergoing surgical renal denervation, percutaneous renal sympathetic nerve ablation, relatively less invasive procedure compared to kidney autotransplantation, was recently introduced as an option for treatment of LPHS . Although this approach potentially provides a pain‐free period up to 2 years, the follow‐up data have been limited and a few studies have demonstrated pain relief only for up to six months .…”

“…In response to excessive incidence of recurrent pain in LPHS patients undergoing surgical renal denervation, percutaneous renal sympathetic nerve ablation, relatively less invasive procedure compared to kidney autotransplantation, was recently introduced as an option for treatment of LPHS . Although this approach potentially provides a pain‐free period up to 2 years, the follow‐up data have been limited and a few studies have demonstrated pain relief only for up to six months . Future studies assessing the cost‐effectiveness of autotransplantation for the treatment of LPHS and comparing kidney autotransplantation with percutaneous renal sympathetic nerve ablation for the treatment of LPHS are needed.…”

“…All patients underwent CT urogram to rule out possible etiologies for hematuria. All cases of LPHS refractory to conservative treatment including pain management with medications, physical therapy, behavioral medicine interventions, and cognitive behavioral therapy were evaluated by nephrologists prior to referral for autotransplantation. A formal psychiatric evaluation was performed on all patients, and active psychosocial pathologies were excluded in all cases prior to the autotransplantation.…”

Does this case hold the answer to one of the worse types of pain in medicine—that of loin pain haematuria syndrome (LPHS)

“…However, once established, these episodes may occur in the absence of visible blood, but haematuria can be detected by cytology in between. The coagulation status of blood in the haematuria is unknown, however, clots have been reported 2 3. If the coagulation cascade is activated, with or without clot disruption, the activation of the complement and plasma protein cascades as well as platelets would release potent mediators such as C3a, C5a, kinins and thromboxane, for which the ureter possesses receptors, and may contract chronically in response 8 9.…”

Loin pain hematuria syndrome

“…Few data exist regarding the epidemiology of LPHS, which is an extremely rare disease with a prevalence of about 0.012%. LPHS is more common in women with as many as 70% of patients with LPHS being females [ 11 ].…”