Reviewed by kidney transplant surgeon, Lloyd E. Ratner, MD, July 2023
Key Facts | Causes | Symptoms | Diagnosis | Treatment | Outlook | Next Steps
Loin Pain Hematuria Syndrome (LPHS) is a rare condition that causes periods of severe intermittent or persistent back, abdominal, or groin pain accompanied by blood in the urine. There are various management strategies available which range from non-invasive to invasive that can improve patient outcomes and quality of life.
LPHS is a complex disease which is difficult to diagnose, and management of the disease requires extensive expertise across different disciplines.
Key Facts
- LPHS is a rare disease that significantly impacts one’s quality of life. Patients with LPHS experience severe flank pain that radiates to the abdomen or groin.
- LPHS occurs more commonly in women than men.
- Causes of LPHS are unknown and the disease is difficult to diagnose.
Causes
Causes of LPHS in most cases are unknown, but often follows an infection. Diseases such as nutcracker syndrome, nephrolithiasis, polycystic kidney disease, and renal thromboembolism may also cause LPHS.
Symptoms
LPHS is a complex and rare condition characterized by a variety of symptoms, which may include:
- Severe, constant or intermittent flank pain that radiates to the abdomen or groin and may be exacerbated even by a gentle touch.
- Pain on one or both sides of the body, and the frequency and length of pain episodes can vary.
- Gross or microscopic hematuria (Blood in the urine).
Diagnosis
There are no well-established diagnostic criteria for the disease. Specific diagnostic work-up depends on the individual clinical features and natural history. A number of tests are done to rule out other possible non-glomerular causes of loin pain and hematuria. (For example, the presence of pain for at least 6 months eliminates the possibility of kidney stone (nephrolithiasis).) Tests for LPHS include:
- Urinalysis
- Cystoscopy
- CT scan
- CT angiography
- Ureteroscopy
A kidney biopsy may be needed to tell the difference between primary (non-glomerular LPHS) and secondary (LPHS caused by glomerular diseases).
Treatment
Treatment for LPHS aims to alleviate symptoms and improve quality of life. It involves a combination of approaches tailored to each individual's needs. A multidisciplinary approach involving various specialists is essential for providing comprehensive care and better outcomes for individuals with LPHS.
- Pain management to relieve symptoms which includes use of analgesic medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids, and nerve block injections.
- Renal autotransplantation is a surgical procedure to reposition the kidney to treat various complex kidney diseases. It can achieve long-term pain relief for HPHS patients.
Outlook
Many LPHS patients have spontaneous remission. Treatment approaches will progress from conservative pain management to more invasive measures.
Next Steps
The Kidney and Pancreas Transplant Program at Columbia has a multidisciplinary team of experts who can work with the patients with loin pain hematuria syndrome to regain and maintain quality of life. If you are in need of a specialist for LPHS, we’re here for you. Call us now at (212) 305-0025 to get started today.