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Loin Pain Hematuria Syndrome - Causes, Symptoms, Diagnosis, and Treatment

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Loin pain hematuria syndrome is a combination of kidney (loin) pain and hematuria (a medical term for blood in urine). Read below to know more.

Published At February 2, 2023
Reviewed AtFebruary 2, 2023

Introduction:

The kidneys are organs that are found in vertebrates. They are located below the rib cage at the side of the spine. The waste from the blood is removed with the help of kidneys and balances the level of calcium, sodium, and potassium in the body. Healthy kidneys help in filtering out some amount of blood every minute. In short, kidneys are essential for filtering out waste and normal functioning of the body. Hematuria is a medical term for blood in the urine, which can be caused due to several reasons, such as infections and kidney diseases.

What Is Loin Pain Hematuria Syndrome?

Loin pain hematuria syndrome (LPHS) is a term used to describe the combination of loin (kidney) pain and hematuria (blood in urine). It is a rare disease with continuous unilateral or bilateral flank pain (continuous pain occurs on one side of the abdomen and lower ribs) along with blood in the urine or hematuria. Around 70 % of patients with LPHS are females, and the condition occurs at 20 to 30 years of age. Hematuria is included in this condition when thick blood clots are not present.

What Are the Causes of Loin Pain Hematuria Syndrome?

Several factors that cause loin pain hematuria syndrome include:

  • IgA Nephropathy - It is also known as Berger’s disease. This kidney disease occurs when the antibody immunoglobulin A (IgA) forms in the kidney and affects the kidney’s function to filter waste from the blood. In addition, certain infections such as HIV (human immunodeficiency virus), liver disease, and genetic disorders can cause this condition.

  • Bladder Infection - They are one of the most common types of urinary tract infections (UTIs). Along with the bladder and urethra, it also affects the kidneys. It is caused when bacteria reach the bladder through the bowel.

  • Nutcracker Syndrome - It compresses the left renal vein, which carries blood away from the left kidney and back to the heart. The compression increases the blood pressure in the renal vein. Specific variation in blood vessels causes nutcracker syndrome, and in some people, it occurs at birth or during adolescence.

  • Thin Basement Membrane Disease - It is one of the most common causes of hematuria. It causes thinning of the basement membrane (a thin extracellular matrix that provides cell and tissue support) of glomeruli (vessels and fibers) in the kidneys.

What Are the Symptoms of Loin Pain Hematuria Syndrome?

The symptoms of loin pain hematuria syndrome are seen depending on the cause due to which it has occurred.

Symptoms of IgA nephropathy include:

  • High blood pressure.

  • Dark-colored urine.

  • Pain in one of the ribs and sometimes on both sides.

  • Swelling around hands and legs.

  • Visible blood in the urine a few times.

Symptoms of a bladder infection include:

  • Frequent urination.

  • A strong smell of urine.

  • Foamy or cloudy urine.

  • Burning sensation during urination.

Symptoms of nutcracker syndrome include:

  • Flank pain on the left side.

  • Feeling dizzy while standing up.

  • Pain during sex and pelvic pain in females.

  • Anemia (low red blood cells).

How Is Loin Pain Hematuria Syndrome Diagnosed?

Depending on the symptoms, a healthcare expert may plan the diagnosis. Specialized tests such as computed tomography (CT), urinalysis, and CT angiography are done to check this condition.

The standard diagnostic aids used for loin pain hematuria syndrome include:

  • Computed Tomography (CT) Scan - This test is mainly done to check for kidney stones and other tumors. From different angles, the x-ray images are taken, and computer processing helps in creating cross-sectional images of soft tissues, bones, and blood vessels. It enables the doctor to examine a particular part of the body in more detail.

  • Urinalysis - It is done to rule out any glomerular infection. A urinalysis is a urine test in which a sample of urine is taken (after six to eight hours of fasting) and tested in the laboratory. The high protein level may indicate glomerular inflammation or infection.

  • CT Angiography - It is done to rule out A-V (arteriovenous) malformation. With the help of a CT scan, a detailed image of the blood vessels and tissues of various parts of the body is taken. A contrast material is injected into the arm’s vein, which flows in the blood vessels and is captured in high-resolution CT images.

What Are the Treatment Options for Loin Pain Hematuria Syndrome?

Many medical treatments for LPHS, such as low-dose aspirin and warfarin, were used but showed significantly less to no effect on the condition. Some of the short-term and reliable treatment options for LPHS include:

  • Oral opioids help in relieving the pain. But they should be given only when it is medicated by a doctor as some people may become addicted to this drug. In addition, in case of severe pain, the level of opioid dose is increased.

  • Sometimes renal denervation is employed, a process where high radiofrequency burns the nerve in renal arteries and helps treat resistant hypertension. However, this procedure only gives temporary relief from pain.

  • Renal autotransplantation is one of the most effective treatments to completely reduce the pain caused by loin pain hematuria syndrome. In this procedure, the doctor removes the kidney that is causing the pain and places it in a new location in the body.

Conclusion:

Loin pain hematuria syndrome is a rare and complex condition. Kidney pain can cause severe effects on an individual’s life. Many conditions, such as nutcracker syndrome and bladder infection, can also lead to this condition. Renal autotransplantation can help in improving the condition and subsiding the pain completely. Still, it is only considered if any other medications or other treatments are not helping, as surgical procedures have their benefits but risk too. So it is necessary never to neglect any visible symptoms of LPHS and contact the doctor. Early diagnosis may help avoid complications and help in treating the condition efficiently.

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Dr. Samer Sameer Juma Ali Altawil
Dr. Samer Sameer Juma Ali Altawil

Urology

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