Successful Use of Renal Denervation in Patients With Loin Pain Hematuria Syndrome—The Regina Loin Pain Hematuria Syndrome Study

Abstract

IntroductionLoin pain hematuria syndrome (LPHS) is characterized by severe unilateral or bilateral loin pain that suggests a renal origin but occurs in the absence of identifiable or relevant urinary tract disease. Hematuria can either be microscopic or macroscopic, but the renal abnormalities responsible for the hematuria are unexplained. Debilitating pain refractory to conventional pain medications is the main cause of morbidity.MethodsWe conducted a single-arm, single-center study. Twelve patients between the ages of 21 and 62 years (11 female, 1 male) with LPHS underwent endovascular ablation of the renal nerves between July 2015 and November 2016, using the Vessix renal denervation system. The primary objective was to achieve 30% reduction in self-reported pain with the McGill Pain Questionnaire (MPQ) at 6 months. The secondary objectives were to measure changes in disability (Oswestry Disability Index [ODI]), mood (Geriatric Depression Scale [GDS]), and quality of life (EuroQol-5D [EQ-5D] and the MOS 36-Item Short Form Survey [SF-36]) scores from baseline to 6 months postprocedure.ResultsTen of 12 patients at 3 months and 11 of 12 patients at 6 months reported a >30% reduction in pain based on the MPQ at 3 and 6 months. We found consistent improvements in MPQ, ODI, GDS, EQ-5D, and SF-36 scores from baseline to 6 months postprocedure.ConclusionWe conclude that renal denervation is associated with a considerable improvement in pain, disability, quality of life, and mood. Our results suggest that percutaneous catheter−based delivery of radiofrequency energy is a safe, rapid treatment option that should be considered in all patients with LPHS.

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

“…Case reports and series from our group and others have shown renal denervation via catheter-based radiofrequency ablation to be an effective therapeutic option for the treatment of LPHS. [10][11][12][13][14] Randomized clinical trial studies are now needed to establish the efficacy of catheter-based renal denervation as a mainstream treatment option in LPHS patients.…”

“…The reduction in pain was accompanied by considerable improvement in functionality, mood, and quality of life. 14 De Jager et al also reported on successful outcomes in 11 patients (6 patients with LPHS and 5 patients with autosomal dominant polycystic kidney disease). A sustained pain reduction effect (up to 12 months) and a significant reduction in medication use were reported in this study.…”

“…There are case reports and small case series that suggest a beneficial effect of catheter-based renal denervation in LPHS. 10 - 14 De Jager et al (n = 6 LPHS patients) and a case report from Italy have shown that catheter-based renal denervation has a positive impact on pain and decreases the use of analgesic medications. 10 , 12 …”

“…The first article outlined 4 successful cases, where “50% experienced complete pain relief post-procedure, whereas the other two patients had a 75% improvement in their frequency of analgesic use.” 13 We had further success in a larger 12-person cohort with LPHS, where pain, mood, disability, and quality of life improved significantly postprocedure. 14 However, these previous studies were limited, as they lacked a control group. To determine whether catheter-based renal denervation is a meaningful addition to the treatment options in these often-difficult-to-treat LPHS patients, a randomized, sham-controlled clinical trial is needed.…”

Triosephosphate-Isomerase Deficiency: Epiphenomenon or Cause of Loin Pain Haematuria Syndrome?

“…Up to now, the pathogenesis is unclear. Pain attacks have been described as severe to extremely severe and have led to a spectrum of non-surgical therapeutic strategies [ 4 ]: analgesics including opioids, ACE-inhibitors [ 8 ], nerve blockade [ 9 , 10 ], dorsal root ganglion stimulation [ 11 , 12 ], intraureteric capsaicin [ 13 ], etc. Surgical strategies range from renal autotransplantation [ 14 , 15 ] to bilateral nephrectomy [ 16 ].…”