Abstract: TH-PO508

Successful Use of Renal Denervation (RDN) in Patients with Loin Pain Hematuria Syndrome (LPHS): The Prairie LPHS Study

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 305 CKD: Clinical Trials and Tubulointerstitial Disorders

Authors

  • Prasad, Bhanu, Regina Qu'Appele Health Regiona, Regina, Saskatchewan, Canada
  • Giebel, Shelley, Regina QuAppelle Health Region, Regina, Saskatchewan, Canada
  • McCarron, Michelle C. E., Regina Qu''Appelle Health Region, Regina, Saskatchewan, Canada
Background

Loin Pain Hematuria Syndrome (LPHS) is a rare disease with a reported prevalence of 0.012%. Its characterized by painful unilateral or bilateral loin pain that suggests a renal origin but occurs in the absence of identifiable or relevant urinary tract disease. Hematuria can be either microscopic or macroscopic, and the renal abnormalities responsible for the hematuria are often unexplained. Debilitating pain refractory to conventional medications lead to multiple trips to the emergency rooms and is the main cause of morbidity. Treatment options include opiates, autotransplantation and autonephrectomy.

Methods

We conducted a single centre, single arm study. Twelve patients between the ages of 21-62 years (eleven females) with LPHS underwent RDN between July 2015 and November 2016 using the Vessix renal denervation system. Secondary causes were excluded by triphasic CT scan of the abdomen and pelvis and MAG3 split function renogram. The primary objective was a 30% reduction in self reported pain using the McGill pain questionnaire (MPQ). The secondary objectives were: changes in self reported diabilitity using Oswestry disability index (ODI), changes in quality of life using the EQ5D, Short Form Health Survey (SF-36), changes in mood using the Geriatric depression score (GDS) at 3 and 6 months as compared to the baseline.

Results

11/12 patients had a >30% reduction in MPQ at 6 months. MPQ score median (IQR) at baseline was 38.5 (34.3-63.8), and 2.0 (0.018.5) at 6 months (p=0.001). ODI (%) mean (IQR) at baseline was 43.5% (20.8-59.3), and 4.4% (0.0-43.0) at 6 months (p=0.003). GDS was 3 (1.3-5) at baseline), and 1(1.0-4.5) at 6 months ) (p=0.002). The visual analogus score (VAS) on EQ5D mean (IQR) improved from 50 (33.8-60.0) at baseline to 75.0 (55.2-88.3) at 6 months (p=0.022). There was consistent improvement across the spectrum of quality of life measures in both EQ5D and SF-36.

Conclusion

This is the first reported study that shows succesful pain relief post RDN in patients with LPHS. There was also considerable improvement in mood, functionality and quality of life post procedure. In a clinical condition, where autrotransplantation and autonephrectomy are considered to be reasonable therapeutic optons, this rapid, safe, minimlly invasive procedure should be considered in all patients with LPHS.