Loin Pain Hematuria Syndrome

Loin Pain Hematuria Syndrome

Xin Gu, MD

In general, kidney biopsies from LPHS patients do not reveal specific pathology. This image shows a normal glomerulus with patent capillary loops and delicate walls. The mesangium is inconspicuous.

This biopsy from an LPHS patient shows a histologically normal cortical tubulointerstitium. The proximal tubules show preserved brush borders. The tubules are back-to-back, and the interstitium is inconspicuous.



  • Loin pain hematuria syndrome (LPHS)


  • Recurrent pain in lower flanks and intermittent hematuria without identifiable cause



  • Proposed classification: Idiopathic disease vs. clinical mimics

  • LPHS: Idiopathic disease

    • Possible etiology: Glomerular capillary hemorrhage

      • RBC and RBC casts obstruct tubules, leading to backleak of glomerular filtration

      • Tubular injury and interstitial edema lead to capsular distension and pain

  • Clinical mimics of LPHS

    • IgA nephropathy

    • Thin basement membrane nephropathy

    • Occult nephrolithiasis

    • Vascular malformation

    • Inflammatory renal vascular diseases

    • Vascular spasm



  • Incidence

    • Diagnosis of exclusion, so incidence cannot be estimated from population-based studies

  • Age

    • Children and adults from 1st to 6th decade

    • Median age: Mid 30s

  • Gender

    • More common in females (70%) than in males (30%)


  • Severe recurrent lower flank pain and hematuria

    • Pain is unilateral at initial presentation

      • Radiates to abdomen, inguinal and inner thigh

    • Eventually may develop bilateral flank pain

    • Hematuria may be gross or microscopic

      • Pain may not always be associated with hematuria

  • Physical examination is unremarkable and nonspecific

    • Costovertebral angle tenderness

    • Low-grade fever may be present

    • No hypertension, except preexisting

Laboratory Tests

  • Urine analysis may show RBCs and RBC casts


  • Options, risks, complications

    • Multidisciplinary pain management

      • Analgesia: NSAIDs and opioids

      • Intraureteric capsaicin

      • Nerve blockade

      • Antidepressants

      • Nephrectomy with autotransplantation


  • Long-term prognosis is excellent

    • Renal function is well preserved

    • Spontaneous resolution in 30% after conservative treatment


Radiographic Findings

  • Normal or nonspecific

  • Minor vascular alterations may present

Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Loin Pain Hematuria Syndrome

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