Loin pain and haematuria in young women: diagnostic pitfalls

Cystoscopy, intravenous urography and urine culture frequently fail to reveal the cause of loin pain and haematuria in young women. Two such women are presented in whom renal biopsy was not only unhelpful but also misleading. Subsequent renal arteriography showed arteriovenous fistulae which were considered erroneously to be the cause of the symptoms in both patients; in fact the fistulae were traumatic post-biopsy fistulae rather than congenital malformations. These patients were probably examples of the "loin/pain/haematuria syndrome" which is thought to have a vascular basis and may have predisposed to the formation of fistulae.