Obstructive uropathy associated with rheumatoid arthritis successfully treated with steroids and immunosuppressive therapy

Chen, Ruxuan; Cao, Siyan; Zhao, Lidan; Yang, Huaxia

doi:10.1097/md.0000000000018415

Cited by 3 publications

(1 citation statement)

References 7 publications

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“…Moreover, iguratimod reduced immune rejection in kidney transplant patients [ 41 , 42 ]. Complete resolution of hematuria, renal injury, and hydronephrosis was reported in a patient with rheumatoid arthritis combined with urinary tract obstruction and acute kidney injury after treatment with prednisone, iguratimod, and leflunomide [ 43 ]. However, it must be noted that iguratimod was not necessarily the drug that exerted the primary therapeutic effect in this case.…”

Section: Discussionmentioning

confidence: 99%

Iguratimod prevents renal fibrosis in unilateral ureteral obstruction model mice by suppressing M2 macrophage infiltration and macrophage–myofibroblast transition

Zhou,

Li,

et al. 2024

Renal Failure

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Iguratimod is a novel synthetic, small-molecule immunosuppressive agent used to treat rheumatoid arthritis. Through ongoing exploration of its role and mechanisms of action, iguratimod has been observed to have antifibrotic effects in the lung and skin; however, its effect on renal fibrosis remains unknown. This study aimed to investigate whether iguratimod could affect renal fibrosis progression. Three different concentrations of iguratimod (30 mg/kg/day, 10 mg/kg/day, and 3 mg/kg/day) were used to intervene in unilateral ureteral obstruction (UUO) model mice. Iguratimod at 10 mg/kg/day was observed to be effective in slowing UUO-mediated renal fibrosis. In addition, stimulating bone marrow-derived macrophages with IL-4 and/or iguratimod, or with TGF-β and iguratimod or SRC inhibitors in vitro , suggested that iguratimod mitigates the progression of renal fibrosis in UUO mice, at least in part, by inhibiting the IL-4/STAT6 signaling pathway to attenuate renal M2 macrophage infiltration, as well as by impeding SRC activation to reduce macrophage–myofibroblast transition. These findings reveal the potential of iguratimod as a treatment for renal disease.

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Section: Discussionmentioning

confidence: 99%

Iguratimod prevents renal fibrosis in unilateral ureteral obstruction model mice by suppressing M2 macrophage infiltration and macrophage–myofibroblast transition

Zhou,

Li,

et al. 2024

Renal Failure

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A case of ureteral stenosis due to ureteritis probably associated with rheumatoid arthritis

Nagamura

Sugitani

2022

Modern Rheumatology Case Reports

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Ureteritis associated with immunological disorder is rarely reported, and most cases in this category are small vessel vasculitis and immunoglobulin G4 (IgG4)-related disease. Rheumatoid arthritis (RA) associated ureteritis is uncommon and underlying etiology is unclear. We present a patient of ureteritis who had medical history of RA and successfully treated with steroid and immunosuppressant. A 49-year-old woman who had been treated for rheumatoid arthritis (RA) and atopic dermatitis (AD) suffered from gross hematuria for five successive days. Contrast enhanced-computed tomography (CE-CT) showed right dominant upper urinary tract dilatation with enhanced thickened wall. The hematuria continued accompanied with intermittent right back and lower abdominal pain, and following CT image taken after three months presented the progression to bilateral hydronephrosis. Ureteral stents were placed and antibiotic therapy was introduced for obstructive pyelonephritis. Ureterocystoscopy and following biopsy from the upper ureteral tract showed chronic inflammatory change in the histopathology, and we finally considered the stenosing ureteritis to be caused by immune-mediated mechanism related to RA. After starting steroid therapy with methotrexate, therapeutic response was obtained to remove the stents. In the cases of ureteritis or ureteral stenosis of unknown etiology with medical history of immunological disorders, we should consider the underlying immune-activated state and try to test CE-CT and histological examination before performing surgical procedure. After excluding the common causes of ureteritis or ureteral stenosis, these tests would support the appropriate diagnosis.

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Bilateral Ureteral Stenosis with Hydronephrosis as First Manifestation of Granulomatosis with Polyangiitis (Wegener’s Granulomatosis): A Case Report and Review of the Literature

Suillot

Bollmann

Rotman

et al. 2020

Case Reports in Nephrology

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Ureteral stenosis is a rare manifestation of granulomatosis with polyangiitis (formerly known as Wegener’s granulomatosis). We report the case of a 76-year-old woman with progressive renal failure in which bilateral hydronephrosis due to ureteral stenosis was the first manifestation of the disease. Our patient also had renal involvement with pauci-immune crescentic glomerulonephritis associated with high titers of anti-proteinase 3 c-ANCAs, but no involvement of the upper or lower respiratory tract. The hydronephrosis and renal function rapidly improved under immunosuppressive therapy with high-dose corticosteroids and intravenous pulse cyclophosphamide. We reviewed the literature and found only ten other reported cases of granulomatosis with polyangiitis/Wegener’s granulomatosis and intrinsic ureteral stenosis: in two cases, the presenting clinical manifestation was unilateral hydronephrosis and in only two others was the hydronephrosis bilateral, but this complication developed during a relapse of the disease. This case emphasizes the importance of including ANCA-related vasculitis in the differential diagnosis of unusual cases of unilateral or bilateral ureteral stenosis.

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Obstructive uropathy associated with rheumatoid arthritis successfully treated with steroids and immunosuppressive therapy

Cited by 3 publications

References 7 publications

Iguratimod prevents renal fibrosis in unilateral ureteral obstruction model mice by suppressing M2 macrophage infiltration and macrophage–myofibroblast transition

Iguratimod prevents renal fibrosis in unilateral ureteral obstruction model mice by suppressing M2 macrophage infiltration and macrophage–myofibroblast transition

A case of ureteral stenosis due to ureteritis probably associated with rheumatoid arthritis

Bilateral Ureteral Stenosis with Hydronephrosis as First Manifestation of Granulomatosis with Polyangiitis (Wegener’s Granulomatosis): A Case Report and Review of the Literature

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