Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Loin pain-hematuria syndrome

Lee A Hebert, MD
Costantino Benedetti, MD
Samir V Parikh, MD
Tibor Nadasdy, MD
Section Editors
Richard J Glassock, MD, MACP
Brad H Rovin, MD
Deputy Editor
Albert Q Lam, MD


The loin pain-hematuria syndrome (LPHS) was first described in 1967 in a report of three young women (20 to 28 years of age) who had recurrent episodes of severe unilateral or bilateral loin (flank) pain that were accompanied by gross or microscopic hematuria [1]. The major causes of flank pain and hematuria, such as nephrolithiasis and blood clot, were not present (see 'Diagnosis' below). Renal arteriography suggested focally impaired cortical perfusion, while renal biopsy showed interstitial fibrosis and arterial sclerosis.

Since the original report, several hundred cases of LPHS have been reported in the medical literature [2].


The epidemiology of loin pain-hematuria syndrome (LPHS) is not well understood. Approximately one-half of our more than 200 LPHS patients reside in Central Ohio, which has a population of two million. If our patients represent one-half of those with LPHS in this region, the prevalence of LPHS is about 0.012 percent. This qualifies LPHS as a rare disease (prevalence less than 0.07 percent) according to the Rare Disease Act of 2002 (House Resolution 4013).


Loin pain-hematuria syndrome (LPHS) is a poorly defined disorder characterized by recurrent or persistent loin (flank) pain and hematuria that appears to represent glomerular bleeding. Most patients present with both manifestations, but some present with loin pain or hematuria alone [3].

Affected patients are typically young (mean age of 31 years in one review, with some cases occurring in teenage children) women (70 to 80 percent in most series), and almost all white [2-5]. As many as 50 percent of patients with LPHS have nephrolithiasis, as defined by either a history of passing stones or, on imaging studies, renal calcifications typical of stones [2].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Dec 22, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Little PJ, Sloper JS, de Wardener HE. A syndrome of loin pain and haematuria associated with disease of peripheral renal arteries. Q J Med 1967; 36:253.
  2. Spetie DN, Nadasdy T, Nadasdy G, et al. Proposed pathogenesis of idiopathic loin pain-hematuria syndrome. Am J Kidney Dis 2006; 47:419.
  3. Dube GK, Hamilton SE, Ratner LE, et al. Loin pain hematuria syndrome. Kidney Int 2006; 70:2152.
  4. Sheil AG, Chui AK, Verran DJ, et al. Evaluation of the loin pain/hematuria syndrome treated by renal autotransplantation or radical renal neurectomy. Am J Kidney Dis 1998; 32:215.
  5. Taba Taba Vakili S, Alam T, Sollinger H. Loin pain hematuria syndrome. Am J Kidney Dis 2014; 64:460.
  6. Monnens LA. Thin glomerular basement membrane disease. Kidney Int 2001; 60:799.
  7. Tryggvason K, Patrakka J. Thin basement membrane nephropathy. J Am Soc Nephrol 2006; 17:813.
  8. Hebert LA, Betts JA, Sedmak DD, et al. Loin pain-hematuria syndrome associated with thin glomerular basement membrane disease and hemorrhage into renal tubules. Kidney Int 1996; 49:168.
  9. Górriz JL, Sancho A, Ferrer R, et al. Renal-limited polyarteritis nodosa presenting with loin pain and haematuria. Nephrol Dial Transplant 1997; 12:2737.
  10. Praga M, Martínez MA, Andrés A, et al. Association of thin basement membrane nephropathy with hypercalciuria, hyperuricosuria and nephrolithiasis. Kidney Int 1998; 54:915.
  11. Smith HS, Bajwa ZH. Loin pain hematuria syndrome-visceral or neuropathic pain syndrome? Clin J Pain 2012; 28:646.
  12. Lucas PA, Leaker BR, Murphy M, Neild GH. Loin pain and haematuria syndrome: a somatoform disorder. QJM 1995; 88:703.
  13. Lall R, Mailis A, Rapoport A. Hematuria-loin pain syndrome: its existence as a discrete clinicopathological entity cannot be supported. Clin J Pain 1997; 13:171.
  14. Bultitude M, Young J, Bultitude M, Allan J. Loin pain haematuria syndrome: distress resolved by pain relief. Pain 1998; 76:209.
  15. Hermens JM, Ebertz JM, Hanifin JM, Hirshman CA. Comparison of histamine release in human skin mast cells induced by morphine, fentanyl, and oxymorphone. Anesthesiology 1985; 62:124.
  16. Prager JP, DeSalles A, Wilkinson A, et al. Loin pain hematuria syndrome: pain relief with intrathecal morphine. Am J Kidney Dis 1995; 25:629.
  17. Hassenbusch S, Burchiel K, Coffey RJ, et al. Management of intrathecal catheter-tip inflammatory masses: a consensus statement. Pain Med 2002; 3:313.
  18. Yaksh TL, Hassenbusch S, Burchiel K, et al. Inflammatory masses associated with intrathecal drug infusion: a review of preclinical evidence and human data. Pain Med 2002; 3:300.
  19. McMillan MR, Doud T, Nugent W. Catheter-associated masses in patients receiving intrathecal analgesic therapy. Anesth Analg 2003; 96:186.
  20. Greenwell TJ, Peters JL, Neild GH, Shah PJ. The outcome of renal denervation for managing loin pain haematuria syndrome. BJU Int 2004; 93:818.
  21. Chin JL, Kloth D, Pautler SE, Mulligan M. Renal autotransplantation for the loin pain-hematuria syndrome: long-term followup of 26 cases. J Urol 1998; 160:1232.
  22. Gambaro G, Fulignati P, Spinelli A, et al. Percutaneous renal sympathetic nerve ablation for loin pain haematuria syndrome. Nephrol Dial Transplant 2013; 28:2393.
  23. Kadi N, Mains E, Townell N, Nabi G. Transperitoneal laparoscopic renal denervation for the management of loin pain haematuria syndrome. Minim Invasive Ther Allied Technol 2013; 22:346.
  24. Almaiman H, Serre JE, Abid N, et al. [A mini-invasive approach to renal autotransplantation in the management of loin pain hematuria syndrome]. Prog Urol 2013; 23:389.
  25. Parnham AP, Low A, Finch P, et al. Recurrent graft pain following renal autotransplantation for loin pain haematuria syndrome. Br J Urol 1996; 78:25.
  26. Cowan NG, Banerji JS, Johnston RB, et al. Renal Autotransplantation: 27-Year Experience at 2 Institutions. J Urol 2015; 194:1357.
  27. Talic RF, Parr N, Hargreave TB. Anephric state after graft nephrectomy in a patient treated with renal autotransplantation for bilateral metachronous loin pain/hematuria syndrome. J Urol 1994; 152:1194.
  28. Winearls CG, Bass C. The loin pain haematuria syndrome. Nephrol Dial Transplant 1994; 9:1537.
  29. Diwakar R, Andrews PA. Renal transplantation in a patient with loin pain hematuria syndrome. Clin Nephrol 2006; 66:144.
  30. Moeschler SM, Hoelzer BC, Eldrige JS. A patient with loin hematuria syndrome and chronic flank pain treated with pulsed radiofrequency of the splanchnic nerves. Clin J Pain 2013; 29:e26.
  31. Uzoh CC, Kumar V, Timoney AG. The use of capsaicin in loin pain-haematuria syndrome. BJU Int 2009; 103:236.
  32. Playford D, Kulkarni H, Thomas M, et al. Intra-ureteric capsaicin in loin pain haematuria syndrome: efficacy and complications. BJU Int 2002; 90:518.
  33. de Beus E, Blankestijn PJ, Fox JG, Zoccali C. Catheter-based renal denervation as a novel treatment for loin pain haematuria syndrome. Nephrol Dial Transplant 2013; 28:2197.
  34. Yatzidis H. Successful sodium thiosulphate treatment for recurrent calcium urolithiasis. Clin Nephrol 1985; 23:63.
  35. Russell A, Chatterjee S, Seed M. Does this case hold the answer to one of the worse types of pain in medicine--that of loin pain haematuria syndrome (LPHS). BMJ Case Rep 2015; 2015.