Loin pain-hematuria syndrome: role for renal autotransplantation.

The loin pain-hematuria syndrome is a poorly understood constellation of symptoms consisting of persistent hematuria and intractable loin pain with negative comprehensive urological evaluation. The patients are severely debilitated by the pain and are usually dependent on narcotics. Various medical and surgical treatments have been tried unsuccessfully, ultimately leading to nephrectomy in many instances. The symptoms may subsequently occur contralaterally. Renal autotransplantation as a form of nephron-sparing denervation therapy for relief of pain was performed on 12 kidneys in 10 patients (2 bilaterally). Excluding 3 patients with followup of less than 1 year (all 3 are pain-free), 8 of the 9 autotransplantations have resulted in dramatic relief of pain, curtailment of narcotic use and return of the patient to normal daily function. Median followup was 43 months (range 15 to 53 months). The remaining patient had pain in the graft area necessitating transplant nephrectomy 4 months later. For patients severely affected by pain and narcotic dependence with this syndrome, renal autotransplantation may provide a nephron-sparing surgical solution.