Recurrent urinary tract infections and bladder dysfunction in systemic lupus erythematosus

Abstract

To assess bladder function in systemic lupus erythematosus (SLE) patients with recurrent urinary tract infections (UTIs). A convenience sample of consecutive patients with SLE (American College of Rheumatology criteria), with recurrent UTIs (>/=3 events in the preceding 12 months), without history of central nervous system involvement, urolithiasis or preceding tuberculosis were studied. Disease activity (SLEDAI-2K), damage (SDI), lower urinary tract symptoms [Pelvic pain and Urgency/Frequency (PUF) and the Interstitial Cystitis Symptom and Problem Index (ICSPI) scales] and Autonomic Symptom Profile (ASP) were assessed. All patients underwent urological examination and urodynamic assessment with cystometry, uroflow, micturition and urethral pressure profile. Ten patients (nine women) were included. The majority of the patients reported urinary symptoms: urgency (n = 8), frequency (n = 8), nocturia (n = 9) and pain (n = 10). The patients had a mean (SD) ICSPI score of 18.4 (9.8), PUF score of 17.4 (5.3) and ASP weighted score of 31.7 (16.1). Abnormal urodynamics findings were identified in seven of the 10 patients, including small bladder capacity (two patients), reduced bladder sensation (four patients), subnormal urinary flow rate (one patient) and a significant amount of residual urine (two patients). The urodynamics findings suggest that bladder dysfunction could be one of the mechanisms involved on the occurrence of recurrent UTIs in patients with SLE. These findings have potential implications for the proper assessment and management of SLE patients with recurrent UTIs. Further studies are needed to corroborate our results.

Infections and systemic lupus erythematosus

“… 20 Despite the controversy, some authors 7 , 21 stated isolated therapy with cyclophosphamide does not seem to be a significant risk factor for infections, but that this risk is increased when the drug is combined with corticoids. In the literature, cyclophosphamide has been associated with urinary tract infections, 21 - 23 corroborating the findings of the present study. The occurrence of hemorrhagic cystitis, one of the known complications of cyclophosphamide, may result in the appearance of urinary reflow, and this, on the other hand, favors more infections.…”

“…The occurrence of hemorrhagic cystitis, one of the known complications of cyclophosphamide, may result in the appearance of urinary reflow, and this, on the other hand, favors more infections. 22 , 23 …”

“… 20 Apesar de controverso, existem autores 7 , 21 que afirmam que a terapia isolada com ciclofosfamida parece não constituir um fator de risco significativo para infecções, mas que esse risco é aumentado quando a mesma é combinada com os corticoides. Na literatura, a ciclofosfamida tem sido associada com infecções de trato urinário, 21 - 23 concordando com os achados do presente estudo. A ocorrência de cistite hemorrágica, uma das conhecidas complicações do uso da ciclofosfamida, pode promover o aparecimento de refluxo urinário e este, por sua vez, favorece o aparecimento de infecções.…”

Comorbid infections in patients with systemic lupus erythematosus: State-of-the-art

“…Фа-кторами риска развития ИМП при СКВ были возраст (ОР=1,1; 95% ДИ 1-1,1; p=0,002), наличие ИМП в анамнезе (ОР=4,5; 95% ДИ 2-10; p=0,0001) и связан-ного с этим факта госпитализации (ОР=15,9; 95% ДИ 2,8-91,1; p=0,002), люпус-нефрит (ОР=2,5; 95% ДИ 1,1-5,7; p=0,036), повышение титров АНФ >1/80 МЕ/мл (ОР=2,8; 95% ДИ 1,2-6,8; p=0,022), тромбоцитопения (ОР=4,3; 95% ДИ 1,3-14,8; p=0,02). Одной из причин рецидивирующих ИМП при СКВ может быть дисфунк-ция мочевого пузыря [51].…”

Infections and Systemic Lupus Erythematosus

“…Urinary tract infections are very common among women with SLE, and the functional derangements previously mentioned are found often, particularly in cases of recurrent infections. E coli and Streptococcus agalactiae were the most prevalent recovered microorganisms (Durán-Barragán et al, 2008). Infections due to Salmonella species are important cause of bacteremia after ingestion of contaminated food; inasmuch as underdeveloped countries have more risk conditions to this infection, it has been reported more frequently in these regions of the world.…”