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and objectives: This article is based on a prospective 10 years observational study on loin pain haematuria syndrome (LPHS) complicating symptomatic nephroptosis (SN) and the results of renal sympathetic denervation and nephropexy (RSD&N) surgery. The objective here is to demonstrate that renal pedicle stretch causes neuro-ischaemia as evidenced by the new IVU 7 sign. Patients and methods: All patients presenting with loin pain with or without hematuria during 10 years were entered into a prospective observational study and underwent thorough clinical, laboratory and imaging investigations. Repeated standard imaging was invariably normal, when supine. However, 190 patients demonstrated SN of > 1.5 vertebrae on repeating intravenous urography (IVU) with erect film. Of whom 36 (18.9%) patients developed recurrent episodes of painful hematuria for which no organic pathology was detected on all imaging, when supinethus fitting the definition of LPHS. The IVU 7 sign, with its horizontal and vertical segments, represents the renal pedicle at supine and erect IVU films, respectively was used for measuring renal pedicle stretch causing renal ischaemia. Results: Results of 190 with SN on IVU-E, 182 were females and 8 males. The mean age was 28.8; duration of symptoms 15.7 and hospital follow up 6.6 years. Patients showed no abnormality on IVU or ancillary imaging when supine. All patients showed renal drop of >1.5 vertebrae (>5cm) on erect IVU film. Other demonstrable pathology on erect IVP film included: pelviuretric junction kink affecting the right kidney in 116 (61.1%) and bilateral in 19 (10%) of patients. Stretch/rotation of renal pedicle causing neuro-ischaemic pain of LPHS was demonstrable on the right side in 72 (37.9%) and bilaterally in 7 patients. Complications of SN on IVU erect film included both obstructive and neuro-ischaemic: obstructive complication included ballooned renal pelvis, hydronephrosis and upper pole diverticulum. Neuro-schaemic complications induced by pedicle stretch and rotation/twist were haematuria of the LPHS affecting 36 (18.9%), auto nephropexy affecting 12 right kidneys, upper pole calyctiasis with extra-vasation affecting 28 (15.8%) right kidney and 2 bilateral that are best shown on RGP. Renal atrophy affected 4 right kidneys. Upper pole infarction affected 2 kidneys. Retrograde pyelography (RGP) also demonstrated upper pole calyctiasis with extra-vasation. Surgical treatment was used in 28 patients; 10 had simple nephropexy and 18 had RSD&N for severe LPHS. Four of patients treated with simple nephropexy had recurrence of LPHS while those who had RSD&N were all cured. Conclusion: Upright IVU film and RGP are essential for the diagnosis of SN complicating into LPHS. The new IVU 7 sign affirms that pedicle stretch causes ischaemic nephropathy. Renal sympathetic denervation and nephropexy is curable for LPHS but simple nephropexy is not.

experimental techniques in urology and nephrology

Loin Pain and Haematuria Syndrome (LPHS) Linked to Symptomatic Nephroptosis (SN) and Revealing Pedicle Stretch Causing Neuro-Ischaemia Using the New IVU 7 Sign