Click below to read Loin Pain Hematuria Syndrome (LPHS) FAQ’s
Click here to read Loin Pain Hematuria Syndrome (LPHS) FAQ’s.
Recommended publications:
https://www.ajkd.org/article/S0272-6386(16)30287-6/fulltext (this is a link to abstract; I already provided you with full text as pdf)
https://www.kireports.org/article/S2468-0249(18)30013-5/fulltext I already provided the full text
https://journals.sagepub.com/doi/10.1177/2054358120951390 I already provided the full text
This is new: https://www.uptodate.com/contents/loin-pain-hematuria-syndrome ( I will provide you with the full text once available)
Loin Pain Hematuria Syndrome: Catheter-Based Renal Denervation for Pain Management
Loin Pain Hematuria Syndrome (LPHS) is a rare clinical disorder with a reported prevalence of 0.012% and typically impacts younger women. Since its initial description in 1967, it remains a poorly understood clinical condition characterized by severe, unilateral or bilateral pain localized to the kidney but in the absence of identifiable urinary tract disease. Patients have debilitating recurrent loin pain with gross or microscopic hematuria. The diagnosis continues to be one of exclusion. There is no consensus on optimal treatment strategies for LPHS.
Due to inadequate understanding of LPHS pathophysiology, the goal of management has been limited to symptomatic relief and pain management. In addition to opioid therapy, interventional management strategies such as intra-ureteric infusions and neuromodulation have been put into practice. However, sporadic success rates, and absence of sustained pain relief has led to continued dependency on opiates often leading to opiate addiction, absenteeism, poor emotional health, and depression. Laparoscopic renal denervation, kidney auto-transplantation, and nephrectomy as a means of interrupting the pain pathways have been associated with better pain relief; however, they are associated with increased risks.
Minimally invasive treatment options are needed for LPHS patients to decrease pain and positively impact the quality of life and level of functioning. The presence of pain-carrying fibres in the renal arterial adventitia presents an opportunity to interrupt the pathways by using radiofrequency nerve ablation as a minimally invasive alternative to surgical options (auto-transplantation and nephrectomy). Case reports and series from our group and others have shown percutaneous catheter-based renal denervation to be an effective therapeutic option for the treatment of LPHS. Our group has published two articles (in American of Journal Kidney Diseases and Kidney International Reports) on the impact of catheter-based renal denervation using VessixTM Renal Denervation System (Boston Scientific Corporation, USA) in LPHS patients. We showed a positive impact on pain, 75% reduction in opioid use and simultaneous improvement in mood, disability and quality of life 6-month post-procedure.
While these studies were promising, they lacked a control group. To determine whether catheter-based renal denervation is a meaningful addition to the treatment options in these opiate-dependent LPHS patients a randomized, sham-controlled clinical trial is needed. Prior to conducting a definitive trial that focuses on patient outcomes, ensuring the feasibility of undertaking such a trial is required. This trial will provide framework and direction for a future multi-center larger trial. As such, we are currently conducting a single-centre, double-blinded, parallel group, sham-controlled, partial crossover, randomized feasibility trial on 10 LPHS patients in Regina General Hospital, which is the renal denervation centre in the province of Saskatchewan, Canada.
Before the randomization phase, 3 LPHS patients went through the renal denervation procedure using Symplicity SpyralTM Renal Denervation System (Medtronic Inc., USA). This allowed our Interventional Radiology team to be monitored by an expert in renal denervation. From January to May 2021, 10 LPHS patients were randomized to one of two arms; 5 patients undertook renal denervation using Symplicity SpyralTM and 5 received sham procedure. The patients were followed up for 6 months and completed questionnaires on pain scores (Brief Pain Inventory and McGill Pain Questionnaire), quality of life (EQ-5D-5L and SF-36), disability (Oswestry Low Back Pain Disability Questionnaire) and depression (CES-D) at baseline, 6-week, 3 and 6-month post procedure. Once the 6-month follow up is complete, the crossover will occur and the patients in sham group will receive renal denervation. Currently we are in the process of unblinding the randomization groups and our preliminary data show promising results.
We anticipate that the results from this feasibility trial will reinforce the results from our earlier, non- blinded studies and provide stronger evidence for the efficacy and safety of catheter-based renal denervation for treatment of LPHS. Given the magnitude of the pain and discomfort observed in LPHS patients, if it is demonstrated that catheter-based renal denervation using in the main trial results in effective pain relief, reduced opiate use and improved quality of life we believe that this trial will have significant impact in making treatment decisions and eventually has the potential of becoming a standard treatment for LPHS patients.
We received financial support from Hospitals of Regina Foundation for conducting this feasibility trial. Also, our team was awarded two grants from Saskatchewan Health Research Foundation and University of Saskatchewan for conducting the study.
In addition, we received an ‘Award of Excellence’ from Saskatchewan Health Research Foundation. This is one of the six provincial awards that recognizes the top-ranked grant applications from Saskatchewan’s health research community in the 2019 competitions.
Our research study protocol was published in the Canadian Journal of Kidney Health and Disease. Once the study is finalized our findings will be published in a scientific journal.
Loin Pain Hematuria Syndrome: Proteomics and Genomics Studies
Proteomics: will provide to you later
Genomics: will provide to you later