2009 Southern Regional Meeting Abstracts

Case Report: INTRODUCTION:The loin pain-hematuria syndrome (LPHS) is characterized by repeated episodes of severe flank pain associated with hematuria without the evidence of major causes for flank pain. LPHS tends to be more common in women and young individuals. Though the disease is associated with IgA nephropathy and nephrolithiasis in some instances, workup remains negative in the majority of cases. Urinalysis is an important diagnostic tool as it may show RBCs. Most LPHS patients end up undergoing kidney biopsy which may demonstrate red blood cells in glomeruli and/or glomerular thinning which indicates glomerular bleeding as the source of hematuria and aid in the diagnosis.
CASE PRESENTATION:We present the case of a 31 year old Hispanic male presenting with severe right sided flank pain for more than one year. Pain appeared to be out of proportion to the clinical findings. The patient reported 3 to 4 episodes of gross hematuria in the past one year.Common causes of hematuria were excluded. Before this presentation, the patient had been worked up at multiple facilities and the diagnosis of LPHS was suspected. Records from outside hospital suggested that patient may have drug seeking behavior. Physical exam on presentation to our facility was unremarkable except for bilateral flank tenderness. Urinalysis showed large blood with more than 75 RBCs per high power field with moderate hyaline casts. CT-scan with stone protocol was negative. Kidney biopsy was done which showed thinning of glomerular membranes and effacement of foot processes.
DISCUSSION:Loin pain-hematuria syndrome is a challenging disease both in terms of diagnosis and management. Patients occasionally are labeled as drug seekers and referred to psychiatry as the work up remains negative. Besides pain control, prevention of exacerbations seems to be the main therapeutic approach. There are reports of ACE inhibitors providing some success in reduction of frequency and severity of exacerbations. In patients with history suggestive of nephrolithiasis, reducing the risks seems to decrease the frequency of attacks. Sodium thiosulfate infusion to dissolve calcium crystals, which may trigger pain, was tried with some success. Invasive procedures like renal denervation and renal autotransplantation appears to be promising but carry the risks of surgery and recurrence of symptoms is not uncommon.