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Published on: May 16, 2025
Obstructive uropathy associated with rheumatoid arthritis successfully treated with steroids and immunosuppressive
Ru-Xuan Chen1, Siyan Stewart Cao2, Li-Dan Zhao1
1Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Clinical Immunology Center, Medical Epigenetics Research Center, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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.
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