Would you perform a kidney biopsy to rule out other etiologies before diagnosing Loin Pain Hematuria Syndrome in a patient with persistent microscopic hematuria, left flank pain, no proteinuria, normal renal function, normal cystoscopy, and normal imaging?

Would you perform a kidney biopsy to rule out other etiologies before diagnosing loin pain hematuria syndrome in a patient with persistent microscopic hematuria, flank pain, no proteinuria, normal renal function, normal cystoscopy, and normal imaging?

• No, the clinical picture is consistent with loin pain hematuria syndrome and a biopsy would not change management
• No, but I would consider noninvasive genetic testing before making the diagnosis
• Yes, I would biopsy to rule out IgA nephropathy or thin basement membrane disease before attributing symptoms to loin pain hematuria syndrome
• Yes, I biopsy all patients with persistent unexplained hematuria regardless of clinical presentation
• Other