HEMATURIA-LOIN-PAIN-SYNDROME - ITS EXISTENCE AS A DISCRETE CLINICOPATHOLOGICAL ENTITY CANNOT BE SUPPORTED

Objective: To (a) review existing literature and current concepts on H ematuria-Loin Pain Syndrome (HLPS) and (b) to describe seven cases of this syndrome, Patients and Setting: Seven HLPS patients seen over a p eriod of 8 years by the pain and nephrology services of the Toronto Ho spital, Toronto, Ontario, Canada. Methods and Results: Retrospective a nalysis was performed. All patients were remarkable for the variabilit y of clinical presentation, pain characteristics, and dissociation of pain and hematuria occurrence. Routine renal investigations revealed d ifferent benign kidney pathologies in 5 of 7 patients. All patients, h owever, displayed variable combinations of personality factors, drug s eeking behaviour, psychopathology, and presence of significant psychos ocial stressors. Four cases were managed conservatively with antidepre ssants, anxiolytics, and supportive counseling and did very well despi te persistent hematuria in two. Conclusions: LPHS does not constitute a distinct clinicopathological entity. in a minority of cases only und erlying kidney pathology is related to pain, and in many cases psychos ocial stressors and underlying psychopathology may play a significant role in the reported disabling pain. A concerted medical/psychological approach is advocated.