Lupus Cystitis, From Myth to Reality: A Narrative Review

Abstract

Systemic lupus erythematosus is a multisystemic disease that usually involves the urinary tract, often in the form of lupus nephritis. However, another form of compromise of this system is lupus cystitis, which, despite being an unusual condition, turns out to be a challenging diagnosis due to the spectrum of nonspecific abdominal and urinary symptoms. Although the exact pathophysiological mechanism of bladder inflammation remains to be established, the role of small vessel vasculitis measured by immune complexes continues to be supported as a central axis for considering possible therapeutic targets. Additionally, there are no clinical studies that dictate a guideline regarding its treatment, however, the evidence from most cases described in the literature suggests the initiation of pulses of methylprednisolone and cyclophosphamide in treatment regimens similar to those of lupus nephritis. Despite its low prevalence, obstructive complications and kidney damage can lead to increased morbidity and mortality.

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

“… 2 In patient 2, we considered that bilateral ureteral dilation and hydronephrosis resulted from just the bladder contraction. In patients with lupus cystitis, the urinary tract is commonly dilated 3 , 4 , 5 but stenosis has been seen in rare case. 6 , 7 Physicians should be careful in diagnosing it.…”