Abstract: TH-PO0480
Loin Pain Hematuria Syndrome (LPHS) in an Anuric Patient on Dialysis: A Case of Diagnostic Delay and Persistent Kidney Pain
Session Information
- Hemodialysis: Novel Markers and Case Reports
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Latif, Muhammad Haris, SSM Health St Mary's Hospital St Louis, St. Louis, Missouri, United States
- Haider, Ali, Nishtar Medical University, Multan, Punjab, Pakistan
- Mazhar, Eman, Nishtar Medical University, Multan, Punjab, Pakistan
- Bastani, Bahar, Saint Louis University, St. Louis, Missouri, United States
Introduction
LPHS is a rare diagnosis typically characterized by flank pain and microscopic hematuria in the absence of identifiable urological pathology. It is infrequently reported in patients with end-stage kidney disease (ESKD), particularly in the setting of anuria, which traditionally excludes LPHS from consideration.
Case Description
We present the case of a young African American man with ESKD on maintenance hemodialysis who experienced recurrent, severe left-sided loin pain over several years. He had no urine output during this time; however, prior records showed consistent microscopic hematuria. A kidney biopsy performed before the onset of anuria revealed diffuse global glomerulosclerosis without active glomerulonephritis. Extensive autoimmune workup was also negative. Imaging—including CT scan, Doppler ultrasound, and MR angiography—ruled out structural causes (nephrolithiasis, obstructive uropathy, or vascular anomalies). His symptoms were attributed to drug-seeking behavior or cyclic vomiting syndrome. His pain was refractory to multiple pharmacologic therapies, including opioids and adjuvant agents. Ultimately, considering his previous hematuria, biopsy findings, and the pattern of his symptoms, he was diagnosed with LPHS, and a multidisciplinary pain management plan was initiated.
Discussion
This case underscores the need to consider LPHS even in dialysis patients, particularly when there is a documented history of unexplained hematuria. It also highlights the importance of longitudinal record review. This case highlights the importance of maintaining a high index of suspicion for renal pain syndromes, even when standard diagnostic markers such as urine output are no longer available. Recognizing LPHS in this context can prevent diagnostic delays, reduce stigma, and improve patient quality of life, even in those without measurable urine output.
MRA of the abdomen showed no vascular or anatomical abnormality in the kidneys.