title: Hematuria-loin pain syndrome: its existence as a discrete clinicopathological entity cannot be supported.
abstract: OBJECTIVE
  To (a) review existing literature and current concepts on Hematuria-Loin Pain Syndrome (HLPS) and (b) to describe seven cases of this syndrome.
  
  
  METHODS
  Seven HLPS patients seen over a period of 8 years by the pain and nephrology services of the Toronto Hospital, Toronto, Ontario, Canada.
  
  
  RESULTS
  Retrospective analysis was performed. All patients were remarkable for the variability of clinical presentation, pain characteristics, and dissociation of pain and hematuria occurrence. Routine renal investigations revealed different benign kidney pathologies in 5 of 7 patients. All patients, however, displayed variable combinations of personality factors, drug seeking behaviour, psychopathology, and presence of significant psychosocial stressors. Four cases were managed conservatively with antidepressants, anxiolytics, and supportive counseling and did very well despite persistent hematuria in two.
  
  
  CONCLUSIONS
  HLPS does not constitute a distinct clinicopathological entity. In a minority of cases only underlying kidney pathology is related to pain, and in many cases psychosocial stressors and underlying psychopathology may play a significant role in the reported disabling pain. A concerted medical/psychological approach is advocated.
authors.affiliation: Pain Investigation Unit, Toronto Hospital, Ontario, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Lall
authors.forename: A
authors.initials: A
authors.lastname: Mailis
authors.forename: A
authors.initials: A
authors.lastname: Rapoport
mesh_terms: D000328:Adult; D005260:Female; D006417:Hematuria / Q000150:complications*; D006801:Humans; D007674:Kidney Diseases / Q000150:complications; D008297:Male; D010146:Pain / Q000150:complications*; D012189:Retrospective Studies