Systemic lupus erythematosus with obstructive uropathy. Case report and review

Area of Science:

• Nephrology
• Rheumatology
• Urology

Background:

• Systemic lupus erythematosus (SLE) is a complex autoimmune disease with diverse clinical manifestations.
• Obstructive uropathy (OU), though uncommon, can be a severe complication of SLE, potentially leading to renal insufficiency.
• Interstitial cystitis (IC) and gastrointestinal (GI) symptoms are frequently observed in SLE patients with OU.

Purpose of the Study:

• To report a unique case of SLE presenting with bilateral hydroureteronephrosis due to ureterovesical junction stricture.
• To review the literature for patterns in SLE patients with obstructive uropathy.
• To highlight the clinical features, underlying causes, and treatment outcomes of OU in SLE.

Main Methods:

• Case presentation of an SLE patient with obstructive uropathy, dysuria, GI symptoms, and renal insufficiency.
• Pathological examination revealing chronic interstitial cystitis with immune complex deposition.
• Literature review of 19 reported cases of SLE associated with obstructive uropathy.

Main Results:

• The index patient's symptoms improved with steroids, but persistent OU necessitated nephrostomy and cyclophosphamide.
• Literature review indicated OU in SLE predominantly affects females (mean age 31.7 years), particularly Orientals (63%).
• Commonly associated conditions include interstitial cystitis (89%), GI involvement (89%), and advanced glomerulonephritis (67%).

Conclusions:

• Obstructive uropathy is a potentially reversible complication of SLE that can be overshadowed by other organ involvement.
• While steroids are effective in many cases (68%), some SLE patients with OU require surgical intervention (32%), with significant mortality (32%).
• Recognition and timely management of OU are crucial for preserving renal function in SLE patients.