Loin Pain Hematuria Syndrome

Definition

Definition of Loin Pain Hematuria Syndrome
Loin pain hematuria syndrome, also LPHS, is the combination of unilateral or bilateral flank pain and microscopic or macroscopic amounts of blood in the urine that is otherwise unexplained.

Symptoms

Symptoms of Loin Pain Hematuria Syndrome
Pain is usually felt in the loin or flank, that is the area above the belly button and around the sides of the body. The pain does not tend to come round to the front, and does not usually spread below this level, but can vary quite a lot from person to person. Pain in this area more usually comes from the muscles and the spine, rather than from the kidney. Loin pain can also be caused by kidney stones or by infection.

Causes

Causes of Loin Pain Hematuria Syndrome
The cause of LPHS is currently not known. One theory proposes that it is caused by a thin glomerular basement membrane and red blood cell (RBC) renal tubular congestion that leads to swelling of the kidney and distension of the renal fascia resulting in pain. At this time no cure has been found for this disease. LPHS is a debilitating disease due to chronic pain and the inability to know how to control the glomerular aspect. The pain of LPHS can be worsened by acts as simple as riding in the car and undertaking daily activities. Many people with this disease are unable to maintain employment due to the debilitating pain.

Diagnosis

Diagnosis of Loin Pain Hematuria Syndrome
LPHS is considered a diagnosis of exclusion. The syndrome presents with hematuria (blood in the urine) and flank (a region of the lower back beneath the ribs and above the ilium) pain which can result from a number of causes.

Treatment

Treatment of Loin Pain Hematuria Syndrome
The treatment of LPHS varies considerably from centre to centre. As the condition is rare and poorly understood, a widely adopted standard of care is not existent.

1. Conservative: Pain management with opiate and non-opiate analgesia is common. Angiotensin converting enzyme inhibitors are thought to be beneficial, as they reduce intraglomerular pressure and, presumably, reduce renal tubular congestion with RBCs.
2. Surgical: Surgery (autotransplantation) is thought by some to be of benefit in selected individuals and advocated in some centres, but usually considered the last resort.

Prognosis

Prognosis of Loin Pain Hematuria Syndrome
There are no recorded cases in which the loin pain haematuria syndrome lasted for life. In most cases, the pain gradually starts to ease off without any medical or surgical therapy, and eventually disappears. The pain sometimes resolves in response to a change in social circumstances. This may take years in some cases, during which time life can be difficult.

Prevention

Prevention of Loin Pain Hematuria Syndrome
Any painkiller can be used for treating the loin pain haematuria syndrome. One of the biggest problems with regards this condition however is that the use of stronger and stronger painkillers can result in problems of drug habituation and dependency. Patients with this condition may become frustrated if they do not always get the strongest possible medicines, but the problem of drug side effects can be serious too.