Severe renal colic caused by kinking ureter. Pain classically relieved a little by going on all fours with hips higher than head. Diagnosis
LPHS is considered a diagnosis of exclusion. The syndrome presents with hematuria (blood in the urine) and flank (a region of the lower back beneath the ribs and above the ilium) pain which can result from a number of causes. Nonglomerular causes of bleeding (e.g., urinary infection, tumor, or nephrolithiasis) must be excluded. Obstruction of the urinary tract should not be present, confirmed by at least two imaging procedures while pain is present. Diagnosis of loin pain-hematuria syndrome (LPHS) occurs when hematuria is present, recurrent or persistent pain is severe, and other causes of bleeding are excluded. Urine testing can be performed to detect microscopic levels of hematuria. Protein is also commonly found in the urine of patients with LPHS. Kidney biopsies are sometimes performed to look for evidence of glomerular hematuria, excess red blood cells in the kidney tubules, and to assess the width of the glomerular basement membrane. Hematuria (more than 5 red blood cells per high power field) should be present in virtually every urinalysis and is typically characterized by dysmorphic red cells. Recurrent or persistent severe pain for  six months or more, occurring in the costovertebral angles. Relation to chronic pelvic pain
LPHS has considerable overlap with chronic pelvic pain syndrome.
Angiotensin converting enzyme inhibitors are thought to be beneficial, as they reduce intraglomerular pressure and, presumably, reduce renal tubular congestion with RBCs.Possible treatment regimens

General
Angiotensin inhibition
Reduce the risk of nephrolithiasis

Pain control
Opioid therapy
Inpatient therapy
Intravenous opioid regimen
Antiemetic drugs
Pruritus management
Maintenance therapy between pain exacerbations

Invasive therapy
Implantable drug delivery system
Surgical renal denervation
Renal autotransplantation
Nephrectomy (NOT recommended)
Other invasive therapies (but not proven effective)
Pulse radio frequency
Celiac plexus block
Intraureteric capsaicin infusionSurgery (autotransplantation) is thought by some to be of benefit in selected individuals and advocated in some centres, but usually considered the last resort.Physicians discourage surgery, as LPHS symptoms often re-occur after autotransplantation. Epidemiology
LPHS is listed as a rare disease in the US National Institute of Health Rare Diseases database. While exact numbers worldwide are not available, the primary LPHS research clinic located in Ohio has over 200 patients. In addition, several hundred other patients have been reported in one study as of 2006. The prevalence of LPHS is estimated  at about 0.012 percent, which qualifies LPHS as a rare disease (prevalence less than 0.07 percent) according to the Rare Diseases Act of 2002. Those affected are usually young, with an average age of 31 years, and 70% to 80% are women. See also
Pelvic pain

References
External links

Loin Pain - Patient UK