Autotransplantation as an effective therapy for the loin pain-hematuria syndrome: case reports and a review of the literature.

PURPOSE: The loin pain-hematuria syndrome is a well recognized but poorly understood clinical condition in which patients have progressive loin pain accompanied by hematuria but they maintain stable renal function. We present 2 cases effectively treated with renal autotransplantation, as well as a review of the literature, and a coherent algorithm for the diagnosis and treatment of this condition.
MATERIALS AND METHODS: The medical literature concerning the loin pain-hematuria syndrome was reviewed. In 1994 we performed renal autotransplantation on 2 patients with the loin pain-hematuria syndrome at our institution.
RESULTS: Extensive urological evaluation revealed no obvious underlying abnormalities in patients with the loin pain-hematuria syndrome. Theories for the pathogenesis of this condition range from thrombotic phenomena to autoimmune processes. Treatment efforts have been directed primarily towards pain management. Narcotic dependence becomes progressive as the pain becomes debilitating. In extreme cases nephrectomy is performed despite normal renal function. Several invasive methods of nerve block and enervation provide only temporary relief. Renal autotransplantation provided lasting cessation of loin pain in both of our patients with followup of 1.5 and 2.5 years, and this intervention has been shown to provide the most durable pain relief in other series.
CONCLUSIONS: Renal autotransplantation provides the most durable, nonnarcotic, nephron sparing relief for patients with the loin pain-hematuria syndrome. Further investigation is necessary to elucidate the pathophysiology of this debilitating condition.