Silent obstruction in a young woman with systemic lupus erythematosus: a case report and literature review on kidney injury from ureteral endometriosis

ABSTRACT

Introduction: Endometriosis is the most common pelvic gynaecologic disorder affecting pre-menopausal women. However ureteral endometriosis (UE) especially intrinsic urinary tract endometriosis is a rare finding that is notorious for causing silent renal insult. The pathogenesis of endometriosis still remains a mystery but studies have suggested an association between endometriosis and systemic lupus erythematosus (SLE) suggesting an immunological aspect to endometriosis. There is very little recognition in the renal literature of the significance of UE leading to progressive kidney injury and the association with autoimmune conditions in particular SLE.

Case description: We present a case of a 30-year old female with a background history of SLE with a silent progressive kidney injury due to an obstructive uropathy secondary to bilateral intrinsic UE and severe loss of her left kidney function that was treated with ureteric stenting. She subsequently underwent bilateral re-implantation of her ureters as a definitive treatment plan as she expressed a wish to conceive.

Discussion: Progressive kidney injury as a result of UE has been reported in the past, however its true incidence is not known. The time of diagnosis is crucial as it reflects renal prognosis. This article outlines the clinical implications from the renal perspective of the disease considering the relevant health problem UE can impose to women. This paper discusses the emerging evidence of an association between SLE and endometriosis that remains poorly understood.

Conclusion: A high index of suspicion is required to diagnose UE as the disease occurs insidiously with non-specific symptoms leading to a silent obstructive uropathy. If missed it can ultimately lead to irreversible kidney dysfunction and mortality. We suggest that patients with endometriosis especially UE should be followed up regularly with renal function testing and imaging. Any health professionals dealing with patients suffering from SLE should consider appropriate investigations and referral if any symptom that suggests endometriosis is reported.

KEYWORDS:

• Endometriosis
• ureteral endometriosis
• systemic lupus erythematous
• kidney injury
• hydronephrosis
• ureteral re-implantation

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.