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Endoscopic findings in loin pain hematuria syndrome: concentric clot in calyceal fornices.

Canales BK, Windsperger A, Lukasewycz S, Monga M - Diagn Ther Endosc (2009)

Bottom Line: To date, the diagnosis of LPHS remains one of exclusion, with some speculation regarding the extent of actual pathology.We report ureteroscopic findings in 2 cases of LPHS.These findings provide objective confirmation of underlying pathology in a difficult-to-manage disease process.

View Article: PubMed Central - PubMed

Affiliation: Department of Urologic Surgery, University of Minnesota, Minneapolis, MN 55455-0392, USA.

ABSTRACT
The loin pain hematuria syndrome (LPHS) creates a considerable burden, both for patients afflicted with the disease and for those involved in medical management and diagnosis. To date, the diagnosis of LPHS remains one of exclusion, with some speculation regarding the extent of actual pathology. We report ureteroscopic findings in 2 cases of LPHS. These findings provide objective confirmation of underlying pathology in a difficult-to-manage disease process.

No MeSH data available.


Related in: MedlinePlus

Ureteroscopic images demonstrating ring-like clots surrounding each calyx in the collecting system.
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fig1: Ureteroscopic images demonstrating ring-like clots surrounding each calyx in the collecting system.

Mentions: Thepathogenesis of flank pain associated with LPHS is thought to be due to glomerularcapillary hemorrhage resulting in tubular obstruction and interstitial edema [6]. Over time, chronic edema is thought to result in capsular distention, pain, andfurther tubular obstruction and hemorrhage. To our knowledge, we are the firstto report the endoscopic findings of LPHS. Both LPHS patients underwentdiagnostic ureteroscopy using minimal irrigation fluid (to avoid distension ofthe renal pelvis) and a wireless, no-touch technique (to rule out iatrogenic,traumatic cause of bleeding). In both patients, ring-like clots consistent withrecent hemorrhage were identified from each fornix surrounding all calyces ofthe collecting system (Figures 1(a) and 1(b)). Because diagnosis is the first step in understanding pathophysiology, wehypothesize that these endoscopic findings may represent a clinical, endoscopicmanifestation of glomerular hemorrhage and obstruction that has not beenpreviously reported.


Endoscopic findings in loin pain hematuria syndrome: concentric clot in calyceal fornices.

Canales BK, Windsperger A, Lukasewycz S, Monga M - Diagn Ther Endosc (2009)

Ureteroscopic images demonstrating ring-like clots surrounding each calyx in the collecting system.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2643052&req=5

fig1: Ureteroscopic images demonstrating ring-like clots surrounding each calyx in the collecting system.
Mentions: Thepathogenesis of flank pain associated with LPHS is thought to be due to glomerularcapillary hemorrhage resulting in tubular obstruction and interstitial edema [6]. Over time, chronic edema is thought to result in capsular distention, pain, andfurther tubular obstruction and hemorrhage. To our knowledge, we are the firstto report the endoscopic findings of LPHS. Both LPHS patients underwentdiagnostic ureteroscopy using minimal irrigation fluid (to avoid distension ofthe renal pelvis) and a wireless, no-touch technique (to rule out iatrogenic,traumatic cause of bleeding). In both patients, ring-like clots consistent withrecent hemorrhage were identified from each fornix surrounding all calyces ofthe collecting system (Figures 1(a) and 1(b)). Because diagnosis is the first step in understanding pathophysiology, wehypothesize that these endoscopic findings may represent a clinical, endoscopicmanifestation of glomerular hemorrhage and obstruction that has not beenpreviously reported.

Bottom Line: To date, the diagnosis of LPHS remains one of exclusion, with some speculation regarding the extent of actual pathology.We report ureteroscopic findings in 2 cases of LPHS.These findings provide objective confirmation of underlying pathology in a difficult-to-manage disease process.

View Article: PubMed Central - PubMed

Affiliation: Department of Urologic Surgery, University of Minnesota, Minneapolis, MN 55455-0392, USA.

ABSTRACT
The loin pain hematuria syndrome (LPHS) creates a considerable burden, both for patients afflicted with the disease and for those involved in medical management and diagnosis. To date, the diagnosis of LPHS remains one of exclusion, with some speculation regarding the extent of actual pathology. We report ureteroscopic findings in 2 cases of LPHS. These findings provide objective confirmation of underlying pathology in a difficult-to-manage disease process.

No MeSH data available.


Related in: MedlinePlus