Endometriosis of the Kidneys

OVERVIEW

Can endometriosis affect the kidneys?

Endometriosis occurs when tissue similar to the lining of the uterus grows outside of the uterus, causing minimal to extensive fibrosis. The disease often adversely affects the functions of the reproductive organs, bowels, and bladder. It can also involve the kidneys. The primary involvement of the kidneys is very rare—kidney endometriosis is often secondary due to a condition called hydroureter (blockage of the ureters).

How common is endometriosis of the kidneys?

Endometriosis of the kidneys is extremely rare, and there are only a few reported cases, but increased endometriosis awareness could change this number. The condition reportedly accounts for less than 1 percent of urinary tract endometriosis, which mostly affects the bladder and only accounts for 1.2 percent of all endometriosis cases [1].

CAUSES

Why does endometriosis affect the kidneys?

The exact cause of endometriosis is not known, and it is even less clear why the condition can affect the kidneys.

Endometrial lesions thicken and shed in response to the ebb and flow of sex hormones during a menstrual cycle. It is thought that this sometimes leads to the formation of endometrioma or endometrial cysts in the kidneys [2]. However, the exact cause is not known. Some researchers think that an overactive immune response may play a role in endometrial lesions infiltrating the kidneys[3].

With each menstrual cycle, more endometrial cysts can accumulate in the kidneys. These cysts may invade the renal capsule, or the fibrous layer surrounding the kidneys, and cause pain. Blood clots may block the ureter and lead to renal colic, a type of kidney pain.

As the condition progresses, the endometrial cysts may even distort the shape of the kidneys and interfere with their normal function.

SYMPTOMS

How can I tell whether or not I have endometriosis of the kidneys?

Kidney endometriosis can be asymptomatic for several years and be discovered by chance while a patient is being tested for other conditions [1].

If a woman who has undergone surgery to treat endometriosis has ongoing urinary problems, it may suggest the presence of urinary tract or kidney endometriosis.

What symptoms could signal kidney endometriosis?

The following symptoms may suggest that a woman may have kidney endometriosis:

• Pain in the lower back that co-occurs with a monthly menstrual cycle. That pain can also extend down through the legs.
• Blood in urine that, again, co-occurs with the menstrual cycle.
• Difficulty urinating.
• Recurrent urinary tract infections.

DIAGNOSIS

Endometriosis of the kidneys is relatively unknown among physicians, and, as a result, patients are often misdiagnosed with kidney cancer. This can lead to delayed treatment, or the patient being wrongly treated.

How can kidney endometriosis be diagnosed?

A specialist should carefully review the patient’s medical history, followed by a pelvic examination. Tell-tale kidney endometriosis symptoms include lower back pain and blood in the urine that comes and goes with the menstrual cycle. Another sign of kidney endometriosis is when the patient’s symptoms disappear with hormonal treatment, such as birth control. Imaging tests such as magnetic resonance imaging (MRI) scans or contrast-enhanced computed tomography (CECT) can also help visualize endometrial lesions in and around the kidneys [1]. However, the way to definitively diagnose kidney endometriosis is via histopathologic examination or the examination of kidney tissue that is obtained using a biopsy, but this approach is very invasive and can lead to complications [4].

TREATMENT

Kidney endometriosis can lead to kidney damage and even kidney failure if left untreated. GnRH agonists and oral contraceptives may be used to manage the symptoms of kidney endometriosis, just like any other kind of endometriosis. However, the best approach is to treat the condition by removing endometrial lesions with minimally invasive laparoscopic surgery. This should be performed by a team of surgeons specializing in gynecological, adrenal, and urological laparoscopic surgery as there is a high risk of complications including damage to the bowel, bladder, ureter, and the organs’ corresponding blood vessels [1]. 

PATIENT STORY

Although endometriosis typically infiltrates the reproductive organs, bowels, and bladder, the disease has other horrifying manifestations. Albeit rare, endometriosis can silently kill function in one or both kidneys. This is called ureteral endometriosis (endometriosis involving the ureters). If endo wraps around one or both ureters, it can cause swelling in the kidney and, left untreated, kidney loss. 

Elina Kharnak is one of the unlucky few; in April, she was diagnosed with kidney endo when it was already too late.

Read More.

References

1. Renal endometriosis mimicking complicated cysts of kidney: report of two cases, D. Giambelluca, D. Albano, E. Giambelluca, A. Bruno,1 F. Panzuto, A. Agrusa, G. Di Buono, F. Cannizzaro, C. Gagliardo, M. Midiri, R. Lagalla, And G. Salvaggio 
2. Renal endometriosis mimicking complicated cysts of kidney: report of two cases, D. Giambelluca, D. Albano, E. Giambelluca, A. Bruno,1 F. Panzuto, A. Agrusa, G. Di Buono, F. Cannizzaro, C. Gagliardo, M. Midiri, R. Lagalla, And G. Salvaggio 
3. Pathophysiology and management of urinary tract endometriosis, Camran Nezhat, Rebecca Falik, Sara McKinney & Louise P. King 
4. Renal Endometriosis Tends to Be Misdiagnosed as Renal Tumor: A Rare Case Report, Jie Yang, Ri-jin Song, Chen Xu, Shi-qing Zhang, and Wei Zhang