Loin pain-hematuria syndrome
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Synopsis
Treatment includes avoidance of pain-inducing activities, pain management (often opioids), surgical renal denervation, and renal autotransplantation.
Although the pathophysiology is still unknown, LPHS does not lead to chronic kidney failure.
This is a clinical diagnosis and one of exclusion. Three conditions should be met:
- Nonglomerular causes of recurrent pain and hematuria first need to be excluded: obstructing nephrolithiasis, urinary tract infection, renal cell carcinoma, autosomal dominant polycystic kidney disease, recurrent renal thromboembolism, endometriosis, and nutcracker syndrome (left renal vein entrapment between the aorta and the superior mesenteric artery).
- Hematuria is present in nearly all urinalyses.
- Pain is consistent with diagnosis (severe, frequently recurrent for 6 months or more, localized to the costovertebral angle, and worsened by percussion).
Codes
ICD10CM:N39.8 – Other specified disorders of urinary system
SNOMEDCT:
86208007 – Loin Pain-Hematuria Syndrome
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Differential Diagnosis & Pitfalls
Differential diagnosis of nonglomerular hematuria and flank pain:- Nephrolithiasis
- Pyelonephritis
- Autosomal dominant polycystic kidney disease
- Renal cell carcinoma
- Renal thromboembolism
- Nutcracker syndrome
- Endometriosis involving the urinary tract
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Last Reviewed:03/10/2020
Last Updated:03/10/2020
Last Updated:03/10/2020