Figure 1: Shows renal pedicle mapped on a supine IVU film (Horizontal, Left) and erect film (Vertical, right) making a figure of 7 where the renal pedicle is stretched to 3 times its normal length, causing stenosis and ischemia

Figure 2: Shows the rubber tube stretch hypothesis where the lower half of the tube is stretched to double the length of horizontal half as compared with IVU 7 sign which confirms that stretch of a tube or artery causes stenosis of the lumen which causes renal ischemia

Figure 3: Severe stenosis of the renal artery and vein in a chronic case of LPHS. The Nelaton tube represents the diameter of normal renal artery

Figure 4: A normal RGP in a case of SN that does not suffer the LPHS

Figure 5: RGP at supine and erect posture with destruction of the upper pole papilla leaking contrast into vein in a case of LPHS. The upper pole is the first and most to be affected

Figure 6: RGP with destruction of the upper pole papilla leaking contrast into a diverticulum in a case of LPHS

Figure 7: RGP with multiple pyelocalyctaisis with erosion of medullary papillae and contrast leakage into veins (papillary venous fistula)- bleeding in LPHS occurs in the opposite direction

Figure 8: Advanced renal medullary papillary destruction in LPHS more severe on the right side

Figure 9: IVU (left) and RGP right of the same patient with LPHS. The IVU looks normal while the RGP shows multiple bilateral papillary necrosis

Figure 10: IVU (left) and RGP (right) of the same patient with chronic long standing LPHS. The IVU looks deceitfully normal while RGP shows massive bilateral destruction of renal papilla