Clinical outcomes of hydronephrosis in patients with systemic lupus erythematosus

In lupus cystitis, is the urinary tract dilated or obstructed?

OBJECTIVES

Lupus cystitis is a rare but serious complication of systemic lupus erythematosus (SLE) that can cause permanent bladder dysfunction, leading to irreversible deterioration of kidney function. We report two cases of SLE with lupus cystitis who showed different images from the same cause of disease.

METHODS

Patient 1, a 67-year-old woman diagnosed with SLE presented with persistent dysuria for 3 weeks with sudden headache and vomiting. She was hospitalized because of acute kidney injury; the serum creatinine level was 10.68 mg/dL. Computed tomography (CT) showed significant bilateral ureteral stenosis and bilateral hydronephrosis. Patient 2, a 45-year-old woman diagnosed with SLE presented with dysuria requiring self-catheterization. CT showed significant bilateral ureteral dilatation and bilateral hydronephrosis.

RESULTS

In patient 1, the right kidney was afunctional. Left nephrostomy was performed on Day 2. Her serum creatinine returned to the normal range. In patient 2, After admission, she changed to an indwelling bladder catheter. Her serum creatinine level improved from 2.04 to 1.31 mg/dL.

CONCLUSION

In patients with lupus cystitis, the urinary tract is commonly dilated, but stenosis has been seen in rare case. Physicians should be careful in diagnosing it.

Ureteritis associated with systemic lupus erythematosus: a case report

We report herein an unusual case of systemic lupus erythematosus in a 35-year-old woman who developed acute abdominal pain while hospitalized. Abdominal computed tomography (CT) scan with enhancement indicated long-segment inflammatory lesions in the right ureter. The patient received spasmolytic and analgesic drugs with poor effect and continued to have persistent severe abdominal pain and signs of peritonitis. We suspected that the patient had acute abdominal disease, but no abnormality was detected during laparoscopic surgery. Therefore, we considered the possibility of right upper urinary tract hydronephrosis; the patient’s abdominal pain was relieved after double-J tube implantation. The patient’s clinical symptoms improved after hormone and mycophenolate mofetil therapy for 1 year, and all laboratory indicators returned to normal. Reexamination by abdominal CT showed that the long-segment inflammatory lesions of the right ureter had resolved. Early identification and diagnosis are important for ureteritis associated with systemic lupus erythematosus.

Very Severe and Refractory Noninfectious Cystitis in Patients with Systemic Lupus Erythematosus: Potential Role of Rituximab Therapy

Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease with various clinical manifestations, including, rarely, a form of interstitial cystitis (lupus cystitis, LC). LC can be asymptomatic and usually has discrete symptoms that improve with conventional therapies available for SLE and/or typical interstitial cystitis. A very severe and refractory form is rarely described. In this study, we present four patients with SLE and a very severe form of noninfectious cystitis refractory to the different forms of treatment described. The clinical descriptions of the cases, demographic factors, manifestations associated with SLE, and clinical and paraclinical manifestations related to cystitis, treatments, and outcomes are provided. A proposal for the pathogenesis of this condition is based on the common findings of these patients, including the fact that three were in SLE remission and all four receiving rituximab as induction and/or maintenance therapy.

Systemic lupus erythematosus gastrointestinal involvement: a computed tomography-based assessment

Systemic lupus erythematosus (SLE) gastrointestinal (GI) complication is characterized by multi-segment and multi-compartment involvement. The aim of this study is to develop a computed tomography (CT) image-based system for disease evaluation. SLE patients with GI involvement from two independent cohorts were retrospectively included. Baseline abdominal CT scan with intravenous and oral contrast was obtained from each individual. A CT scoring system incorporating the extent of GI tract involvement and intestinal wall thickness, along with extra-GI compartment involvement, was developed and validated. The outcome measurement was the time to GI functional recovery, defined as the time to tolerable per os (PO) intake ≥50% of ideal calories (PO50). A total of 54 and 37 patients with SLE GI involvement were enrolled in the derivation and validation cohorts, respectively. The CT scores for SLE GI involvement were positively correlated with patients' time to PO50 (r = 0.57, p < 0.0001, derivation cohort; r = 0.42, p = 0.0093, validation cohort). Patients with a CT score ≤ 3 had a shorter time to PO50 (median time of 0 day) in pooled cohort, whereas those with a CT score > 3 incurred a significantly prolonged recovery with a median time to PO50 of 13 days (p < 0.0001). The CT-based scoring system may facilitate more accurate assessment and individualized management of SLE patients with GI involvement.

Obstructive uropathy associated with rheumatoid arthritis successfully treated with steroids and immunosuppressive therapy: A case report

RATIONALE

Urinary obstruction are relatively rare complications of autoimmune diseases including systemic lupus erythematosus and systemic vasculitis. It has never been reported in rheumatoid arthritis (RA).

PATIENT CONCERNS

We report a case of a female patient with seropositive RA who presented with gross hematuria associated with worsening joint symptoms, found to have acute kidney injury (AKI), bilateral hydronephrosis with bilateral renal pelvis, and ureteral wall thickening. Uroscopy with biopsy demonstrated inflammation without evidence of malignancy.

DIAGNOSES

Rheumatoid arthritis related inflammation and obstruction of the urinary tract.

INTERVENTIONS

Prednisone 50 mg daily (tapering began 1 month later), iguratimod 50 mg daily, and leflunomide 20 mg daily were prescribed.

OUTCOMES

The patient responded well to steroids and immunosuppressive therapy with complete resolution of hematuria, renal injury, and hydronephrosis.

LESSONS

Our case showed that RA might cause local inflammation involving the urinary tract which leads to obstruction and AKI.

Systemic lupus erythematosus of the urinary tract: focus on lupus cystitis

Systemic lupus erythematosus (SLE) frequently manifests as urinary tract disease, most commonly in the form of lupus nephritis. Bladder involvement in the disease course takes a subclinical form and may affect both children and adults. Lupus cystitis can precede SLE diagnosis and may present with very unspecific urinary and digestive tract symptoms or no symptoms at all. The exact mechanism of bladder inflammation in lupus is not fully understood; however, histopathological studies suggest a possible role of immune complex-mediated small vessel vasculitis. Lupus cystitis is a rare SLE manifestation, but poses a challenge for physicians, due to its complex diagnostics and treatment.