Ahmed and colleagues describe a novel method of treating loin pain haematuria syndrome (LPHS). There is no established treatment pathway for this difficult disorder. The authors have identified aggressive treatment strategies; however, many believe it has a significant somatoform component. Bass et al.,1 in 21 cases of patients referred from regional renal centres found 12 to have recurrent, unexplained symptoms involving other body parts. They now advocate once a diagnosis has been made, that patients are managed in a multidisciplinary regional clinic involving pain consultants and psychiatrists.
LPHS is a diagnosis of exclusion. Therefore, extensive investigation needs to be carried out. Should we be carrying out angiography in these patients to rule out arteriovenous malformations (AVMs)? These may be otherwise missed on IVU/ultrasound giving a presumptuous LPHS diagnosis. Renal AVMs are rare, with a reported prevalence of 0.04%.2 However, with LPHS being rarer (estimated prevalence of 0.012%3), should we be standardising our diagnosis of exclusion?
The half-life of bupivacaine is approximately 3 h. It is surprising that 23% of patients treated had complete resolution after one instillation. Furthermore, ensuring enduring absorption and stasis in the renal tract must be difficult at the very least. A placebo-controlled trial would undoubtedly be of great interest.
References
- 1.Bass CM, Parrott H, Jack T, Baranowski A, Neild GH. Severe unexplained loin pain (loin pain haematuria syndrome): management and long term outcome. Q J Med. 2007;100:369–81. doi: 10.1093/qjmed/hcm034. [DOI] [PubMed] [Google Scholar]
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