系统性红斑狼疮继发上尿路梗阻引起肾积水2例报告并文献复习

Two cases report of hydronephrosis caused by upper urinary tract obstruction secondary to systemic lupus erythematosus and literature review

目的:探讨系统性红斑狼疮(SLE)继发上尿路梗阻引起肾积水的诊断及治疗方法。方法:回顾分析我院收治的2例SLE继发上尿路梗阻引起肾积水患者的临床资料:第1例患者CTU提示左腹膜后肿物压迫输尿管,第2例患者CTU提示左输尿管上段轻度狭窄伴左肾盂轻度扩张积水,考虑为炎性狭窄可能性大。结果:第1例患者病理检查证实SLE继发腹膜后纤维化,治疗上应用糖皮质激素联合免疫抑制剂,患者应用药物3个月后肾积水明显好转。第2例患者考虑SLE继发左输尿管炎性狭窄,置入输尿管支架管,2个月后患者症状完全缓解,拔除输尿管支架管后随访6个月,肾积水未复发。结论:SLE继发上尿路梗阻引起肾积水是一种罕见疾病,主要表现为继发腹膜后纤维化压迫输尿管,也可致输尿管炎性狭窄,确诊需要依靠组织病理活检。治疗上以治疗SLE为主,梗阻严重影响肾功能,应尽早行外科手术解除梗阻,保护肾功能。

Objective：To discuss diagnosis and treatment of hydronephrosis caused by upper urinary tract obstruction secondary to systemic lupus erythematosus（SLE）.Method：We analysed the clinical data of two patients who suffered from hydronephrosis caused by upper urinary tract obstruction secondary to SLE.The CTU of the first one demonstrated there was a mass at the left retroperitoneal space,which made the ureter pressed,while the CTU of the second revealed that there was light narrow of the left ureter with a left hydronephrosis,which was probably caused by inflammation.Result：The pathological examination of the first patient demonstrated retroperitoneal fibrosis was secondary to SLE.After three months＇ treatment of glucocorticoids and immunosuppressor,the hydronephrosis significantly improved.The left ureter inflammatory stricture of the second one was considered as a result of SLE,who underwent retrograde ureteral catheterization and two month later the patient recovered,then we removed the ureteral stent.After 6-month follow-up,the hydronephrosis didn＇t relapse.Conclusion：Hydronephrosis caused by upper urinary tract obstruction secondary to SLE is a rare disease.The main performance of which is retroperitoneal fibrosis,also it can cause light narrow of the left ureter.The diagnosis has to rely on pathological examination,and the treatment is based on SLE.The early operation is required if there is a severe ureteral obstruction to protect the renal function.