Ivan Urits1,2, Nathan Li3, Amnon A Berger4, Paul Walker5, Brendan Wesp6, Alec M Zamarripa7, Daniel An6, Elyse M Cornett2, Alaa Abd-Elsayed8, Alan D Kaye2. 1. Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA. 2. Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA. 3. Medical College of Wisconsin, Wauwatosa, WI, USA. 4. Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA. amnon.berger@mail.huji.ac.il. 5. Weill Cornell Medical College, New York, NY, USA. 6. Georgetown University School of Medicine, Washington, DC, USA. 7. University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA. 8. Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Abstract
PURPOSE OF REVIEW: 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. RECENT FINDINGS: 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.
PURPOSE OF REVIEW: 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. RECENT FINDINGS: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 LPHSpatients 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.
Authors: M Praga; M A Martínez; A Andrés; R Alegre; J Vara; E Morales; J C Herrero; O Novo; J L Rodicio Journal: Kidney Int Date: 1998-09 Impact factor: 10.612
Authors: Dan N Spetie; Tibor Nadasdy; Gyongyi Nadasdy; Garima Agarwal; Michael Mauer; Anil K Agarwal; Hooman Khabiri; Haikady N Nagaraja; N Stanley Nahman; Judith A Hartman; Lee A Hebert Journal: Am J Kidney Dis Date: 2006-03 Impact factor: 8.860