Obstructive uropathy associated with rheumatoid arthritis successfully treated with steroids and immunosuppressive therapy: A case report

Rationale:Urinary obstruction are relatively rare complications of autoimmune diseases including systemic lupus erythematosus and systemic vasculitis. It has never been reported in rheumatoid arthritis (RA).Patient concerns:We report a case of a female patient with seropositive RA who presented with gross hematuria associated with worsening joint symptoms, found to have acute kidney injury (AKI), bilateral hydronephrosis with bilateral renal pelvis, and ureteral wall thickening. Uroscopy with biopsy demonstrated inflammation without evidence of malignancy.Diagnoses:Rheumatoid arthritis related inflammation and obstruction of the urinary tract.Interventions:Prednisone 50mg daily (tapering began 1 month later), iguratimod 50mg daily, and leflunomide 20mg daily were prescribed.Outcomes:The patient responded well to steroids and immunosuppressive therapy with complete resolution of hematuria, renal injury, and hydronephrosis.Lessons:Our case showed that RA might cause local inflammation involving the urinary tract which leads to obstruction and AKI.