Symptomatic Nephroptosis (SN) Causes the Loin Pain and Haematuria Syndrome (LPHS)_ Crimson Publishers

 Symptomatic Nephroptosis (SN) Causes the Loin Pain and Haematuria Syndrome (LPHS) by Ahmed N Ghanem* in Surgical Medicine Open Access Journal_ Surgical Medicine Open Access Journal

 

Abstract

The objective of this letter is to report recent advances on the diagnosis and therapy of the loin pain hematuria syndrome (LPHS). The patho-aetiological link of LPHS with symptomatic nephroptosis (SN) is a novel discovery of the 21st century that was first preliminary reported in 2002 [1]. The link was confirmed in 2016 in an article that précised the exact pathoaetiology of LPHS; ischemic nephritis and sympathetic neuropathy of SN. It also advanced a 100% curative therapy for LPHS namely; the renal sympathetic denervation and nephropexy (RSD&N) surgery [2]. Symptomatic nephroptosis has been known for centuries [3] but was disparaged [4] >70 years ago and omitted from all textbooks. Hence it is a forgotten disease. The loin pain hematuria syndrome was first reported in 1967 [5] and has remained without any effective therapy till now

The discovery of SN causing LPHS and the successful curable therapy are based on a prospective cohort 10 years study [1,2] of 190 patients diagnosed with SN among whom 36(18.9%) patients developed LPHS. Two new signs that demonstrate renal pedicle stretch of SN (Figure 1) causes vessel stenosis and ischemic nephritis as evidenced by the new IVU7 sign and tube stretch hypothesis (Figure 2 & 3). These signs demonstrate that stretching of renal artery in pedicle at erect posture causes vessels stenosis, diminished blood flow and induces ischemic nephritis and sympathetic neuropathy. This is illustrated by producing the same effect on stretching a rubber catheter tube causing stenosis (reduced diameter) that diminishes lumen flow. Lumen flow of the blood vessel or catheter is completely obliterated when stretch of more than double the length of vessel or tube is accompanied by rotation twist. Ischemic nephritis affects the renal medulla long before the cortex, particularly eroding the medullary papillae creating fistulae between renal blood vessels and the collecting system explaining the venous shunt causing the hematuria. This is demonstrated only on retrograde pyelography (RGP) (Figure 4 & 5). So, the diagnosis of SN is only possible on intravenous urography (IVU) with erect film (IVU-E) on which the IVU7 sign demonstrates renal drop and pedicle stretch (Figure 1 & 2) and RGP that demonstrates medullary damage (Figure 4 & 5) while all other imaging including CAT and MRI are useless being feasible only on supine posture

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