Skip to main content

Nephro-Urological Involvement

  • Chapter
  • First Online:
Sjögren’s Syndrome

Abstract

One of the parenchymal organs that can be affected in patients with Sjögren’s ­syndrome (SS) is the kidney [1]. Kidneys in primary SS (pSS) can be a target of the immune system either by activated lymphocytes that infiltrate the renal interstitium resulting in interstitial nephritis (IN) or by an immune complex mediated process appearing as glomerulonephritis (GN). Furthermore, epidemiologic and immunologic data suggest an association between SS and painful bladder syndrome/interstitial cystitis (PBS/IC), a chronic pelvic pain syndrome that produces lower urinary symptoms such as discomfort related to bladder, nocturia, frequency, and urge to void [1].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Tzioufas G, Mitsias D, Moutsopoulos H. Sjogren’s syndrome. In: Hochberg M, Smolen J, Weinblatt M, Weisman M, editors. Rheumatology. 4th ed. Mosby: Elsevier; 2008. p. 1341.

    Google Scholar 

  2. Kahn M, Merritt AD, Wohl MJ, et al. Renal concentrating defect in Sjogren’s syndrome. Ann Intern Med. 1962;56:883–95.

    PubMed  CAS  Google Scholar 

  3. Shearn MA, Tu WH. Nephrogenic diabetic insipidus and other defects of renal tubular function in Sjoergren’s syndrome. Am J Med. 1965;39:312–8.

    Article  PubMed  CAS  Google Scholar 

  4. Bloch KJ, Buchanan WW, Wohl MJ, et al. Sjogren’s syndrome. A clinical, pathological, and serological study of sixty-two cases. Medicine (Baltimore). 1965;44:187–231.

    Article  CAS  Google Scholar 

  5. Shearn MA, Tu WH. Latent renal tubular acidosis in Sjogren’s syndrome. Ann Rheum Dis. 1968;27:27–32.

    Article  PubMed  CAS  Google Scholar 

  6. Tu WH, Shearn MA, Lee JC, et al. Interstitial nephritis in Sjogren’s syndrome. Ann Intern Med. 1968;69:1163–70.

    PubMed  CAS  Google Scholar 

  7. Talal N, Zisman E, Schur PH. Renal tubular acidosis, glomerulonephritis and immunologic factors in Sjogren’s syndrome. Arthritis Rheum. 1968;11:774–86.

    Article  PubMed  CAS  Google Scholar 

  8. Shioji R, Furuyama T, Onodera S, et al. Sjogren’s syndrome and renal tubular acidosis. Am J Med. 1970;48:456–63.

    Article  PubMed  CAS  Google Scholar 

  9. Eriksson P, Denneberg T, Enestrom S, et al. Urolithiasis and distal renal tubular acidosis preceding primary Sjogren’s syndrome: a retrospective study 5–53 years after the presentation of urolithiasis. J Intern Med. 1996;239:483–8.

    Article  PubMed  CAS  Google Scholar 

  10. Pertovaara M, Korpela M, Pasternack A. Factors predictive of renal involvement in patients with primary Sjogren’s syndrome. Clin Nephrol. 2001;56:10–8.

    PubMed  CAS  Google Scholar 

  11. Aasarod K, Haga HJ, Berg KJ, et al. Renal involvement in primary Sjogren’s syndrome. QJM. 2000;93:297–304.

    Article  PubMed  CAS  Google Scholar 

  12. Bossini N, Savoldi S, Franceschini F, et al. Clinical and morphological features of kidney involvement in primary Sjogren’s syndrome. Nephrol Dial Transplant. 2001;16:2328–36.

    Article  PubMed  CAS  Google Scholar 

  13. Pertovaara M, Korpela M, Kouri T, et al. The occurrence of renal involvement in primary Sjogren’s syndrome: a study of 78 patients. Rheumatology (Oxford). 1999;38:1113–20.

    Article  CAS  Google Scholar 

  14. Pokorny G, Sonkodi S, Ivanyi B, et al. Renal involvement in patients with primary Sjogren’s syndrome. Scand J Rheumatol. 1989;18:231–4.

    Article  PubMed  CAS  Google Scholar 

  15. Viergever PP, Swaak TJ. Renal tubular dysfunction in primary Sjogren’s syndrome: clinical studies in 27 patients. Clin Rheumatol. 1991;10:23–7.

    Article  PubMed  CAS  Google Scholar 

  16. Vitali C, Tavoni A, Sciuto M, et al. Renal involvement in primary Sjogren’s syndrome: a retrospective-prospective study. Scand J Rheumatol. 1991;20:132–6.

    Article  PubMed  CAS  Google Scholar 

  17. Siamopoulos KC, Mavridis AK, Elisaf M, et al. Kidney involvement in primary Sjogren’s syndrome. Scand J Rheumatol Suppl. 1986;61:156–60.

    PubMed  CAS  Google Scholar 

  18. Moutsopoulos HM, Cledes J, Skopouli FN, et al. Nephrocalcinosis in Sjogren’s syndrome: a late sequela of renal tubular acidosis. J Intern Med. 1991;230:187–91.

    Article  PubMed  CAS  Google Scholar 

  19. Aygen B, Dursun FE, Dogukan A, et al. Hypokalemic quadriparesis associated with renal tubular acidosis in a patient with Sjogren’s syndrome. Clin Nephrol. 2008;69:306–9.

    PubMed  CAS  Google Scholar 

  20. Dowd JE, Lipsky PE. Sjogren’s syndrome presenting as hypokalemic periodic paralysis. Arthritis Rheum. 1993;36:1735–8.

    Article  PubMed  CAS  Google Scholar 

  21. Soy M, Pamuk ON, Gerenli M, et al. A primary Sjogren’s syndrome patient with distal renal tubular acidosis, who presented with symptoms of hypokalemic periodic paralysis: report of a case study and review of the literature. Rheumatol Int. 2005;26:86–9.

    Article  PubMed  Google Scholar 

  22. Zimhony O, Sthoeger Z, Ben David D, et al. Sjogren’s syndrome presenting as hypokalemic paralysis due to distal renal tubular acidosis. J Rheumatol. 1995;22:2366–8.

    PubMed  CAS  Google Scholar 

  23. Ren H, Wang WM, Chen XN, et al. Renal involvement and follow-up of 130 patients with primary Sjogren’s syndrome. J Rheumatol. 2008;35:278–84.

    PubMed  CAS  Google Scholar 

  24. Kobayashi T, Muto S, Nemoto J, et al. Fanconi’s syndrome and distal (type 1) renal tubular acidosis in a patient with primary Sjogren’s syndrome with monoclonal gammopathy of undetermined significance. Clin Nephrol. 2006;65:427–32.

    PubMed  CAS  Google Scholar 

  25. Yang Y, Kuang Y, Montes De Oca R. Targeted disruption of the murine Fanconi anemia gene, Fancg/Xrcc9. Blood. 2001;98:3435–40.

    Article  PubMed  CAS  Google Scholar 

  26. Goules A, Masouridi S, Tzioufas AG, et al. Clinically significant and biopsy-documented renal involvement in primary Sjogren syndrome. Medicine (Baltimore). 2000;79:241–9.

    Article  CAS  Google Scholar 

  27. Matsumura R, Kondo Y, Sugiyama T, et al. Immunohistochemical identification of infiltrating mononuclear cells in tubulointerstitial nephritis associated with Sjogren’s syndrome. Clin Nephrol. 1988;30:335–40.

    PubMed  CAS  Google Scholar 

  28. Rosenberg ME, Schendel PB, McCurdy FA, et al. Characterization of immune cells in kidneys from patients with Sjogren’s syndrome. Am J Kidney Dis. 1988;11:20–2.

    PubMed  CAS  Google Scholar 

  29. Murata H, Kita Y, Sakamoto A, et al. Limited TCR repertoire of infiltrating T cells in the kidneys of Sjogren’s syndrome patients with interstitial nephritis. J Immunol. 1995;155:4084–9.

    PubMed  CAS  Google Scholar 

  30. Matsumura R, Umemiya K, Nakazawa T, et al. Expression of cell adhesion molecules in tubulointerstitial nephritis associated with Sjogren’s syndrome. Clin Nephrol. 1998;49:74–81.

    PubMed  CAS  Google Scholar 

  31. Matsumura R, Umemiya K, Goto T, et al. Glandular and extraglandular expression of costimulatory molecules in patients with Sjogren’s syndrome. Ann Rheum Dis. 2001;60:473–82.

    Article  PubMed  CAS  Google Scholar 

  32. Matsumura R, Umemiya K, Kagami M, et al. Glandular and extraglandular expression of the Fas-Fas ligand and apoptosis in patients with Sjogren’s syndrome. Clin Exp Rheumatol. 2001;16:561–8.

    Google Scholar 

  33. Nishimori I, Bratanova T, Toshkov I, et al. Induction of experimental autoimmune sialoadenitis by immunization of PL/J mice with carbonic anhydrase II. J Immunol. 1995;154:4865–73.

    PubMed  CAS  Google Scholar 

  34. Inagaki Y, Jinno-Yoshida Y, Hamasaki Y, et al. A novel autoantibody reactive with carbonic anhydrase in sera from patients with systemic lupus erythematosus and Sjogren’s syndrome. J Dermatol Sci. 1991;2:147–54.

    Article  PubMed  CAS  Google Scholar 

  35. Itoh Y, Reichlin M. Antibodies to carbonic anhydrase in systemic lupus erythematosus and other rheumatic diseases. Arthritis Rheum. 1992;35:73–82.

    Article  PubMed  CAS  Google Scholar 

  36. Kino-Ohsaki J, Nishimori I, Morita M, et al. Serum antibodies to carbonic anhydrase I and II in patients with idiopathic chronic pancreatitis and Sjogren’s syndrome. Gastroenterology. 1996;110:1579–86.

    Article  PubMed  CAS  Google Scholar 

  37. Takemoto F, Hoshino J, Sawa N, et al. Autoantibodies against carbonic anhydrase II are increased in renal tubular acidosis associated with Sjogren syndrome. Am J Med. 2005;118:181–4.

    Article  PubMed  CAS  Google Scholar 

  38. Takemoto F, Katori H, Sawa N, et al. Induction of anti-carbonic-anhydrase-II antibody causes renal tubular acidosis in a mouse model of Sjogren’s syndrome. Nephron Physiol. 2007;106:p63–8.

    Article  PubMed  CAS  Google Scholar 

  39. Rodriguez Soriano J. Renal tubular acidosis: the clinical entity. J Am Soc Nephrol. 2002;13:2160–70.

    Article  PubMed  Google Scholar 

  40. Maldonado JE, Velosa JA, Kyle RA, et al. Fanconi syndrome in adults. A manifestation of a latent form of myeloma. Am J Med. 1975;58:354–64.

    Article  PubMed  CAS  Google Scholar 

  41. Donckerwolcke RA, van Stekelenburg GJ, Tiddens HA. Therapy of bicarbonate-losing renal tubular acidosis. Arch Dis Child. 1970;45:774–9.

    Article  PubMed  CAS  Google Scholar 

  42. Maripuri S, Grande JP, Osborn TG, et al. Renal involvement in primary Sjogren’s syndrome: a clinicopathologic study. Clin J Am Soc Nephrol. 2009;4:1423–31.

    Article  PubMed  Google Scholar 

  43. Meltzer M, Franklin EC, Elias K, et al. Cryoglobulinemia – a clinical and laboratory study. II. Cryoglobulins with rheumatoid factor activity. Am J Med. 1966;40:837–56.

    Article  PubMed  CAS  Google Scholar 

  44. Brouet JC, Clauvel JP, Danon F, et al. Biologic and clinical significance of cryoglobulins. A report of 86 cases. Am J Med. 1974;57:775–88.

    Article  PubMed  CAS  Google Scholar 

  45. Moutsopoulos HM, Balow JE, Lawley TJ, et al. Immune complex glomerulonephritis in sicca syndrome. Am J Med. 1978;64:955–60.

    Article  PubMed  CAS  Google Scholar 

  46. Sato K, Miyasaka N, Nishioka K, et al. Primary Sjogren’s syndrome associated with systemic necrotizing vasculitis: a fatal case. Arthritis Rheum. 1987;30:717–8.

    Article  PubMed  CAS  Google Scholar 

  47. Tsokos M, Lazarou SA, Moutsopoulos HM. Vasculitis in primary Sjogren’s syndrome. Histologic classification and clinical presentation. Am J Clin Pathol. 1987;88:26–31.

    PubMed  CAS  Google Scholar 

  48. Ferri C, Zignego AL, Pileri SA. Cryoglobulins. J Clin Pathol. 2002;55:4–13.

    Article  PubMed  CAS  Google Scholar 

  49. Dimitrakopoulos AN, Kordossis T, Hatzakis A, et al. Mixed cryoglobulinemia in HIV-1 infection: the role of HIV-1. Ann Intern Med. 1999;130:226–30.

    PubMed  CAS  Google Scholar 

  50. Vitali C, Sciuto M, Neri R, et al. Anti-hepatitis C virus antibodies in primary Sjogren’s syndrome: false positive results are related to hyper-gamma-globulinemia. Clin Exp Rheumatol. 1992;10:103–4.

    PubMed  CAS  Google Scholar 

  51. Abrams P, Baranowski A, Berger RE, et al. A new classification is needed for pelvic pain syndromes – are existing terminologies of spurious diagnostic authority bad for patients? J Urol. 2006;175:1989–90.

    Article  PubMed  Google Scholar 

  52. Fall M, Baranowski AP, Fowler CJ, et al. EAU guidelines on chronic pelvic pain. Eur Urol. 2004;46:681–9.

    Article  PubMed  CAS  Google Scholar 

  53. Janicki TI. Chronic pelvic pain as a form of complex regional pain syndrome. Clin Obstet Gynecol. 2003;46:797–803.

    Article  PubMed  Google Scholar 

  54. van de Merwe JP, Nordling J, Bouchelouche P, et al. Diagnostic criteria, classification, and nomenclature for painful bladder syndrome/interstitial cystitis: an ESSIC proposal. Eur Urol. 2008;53:60–7.

    Article  PubMed  Google Scholar 

  55. Hanash KA, Pool TL. Interstitial cystitis in men. J Urol. 1969;102:427–8.

    PubMed  CAS  Google Scholar 

  56. Messing EM, Stamey TA. Interstitial cystitis: early diagnosis, pathology, and treatment. Urology. 1978;12:381–92.

    Article  PubMed  CAS  Google Scholar 

  57. Van de Merwe J, Kamerling R, Arendsen E, et al. Sjogren’s syndrome in patients with interstitial cystitis. J Rheumatol. 1993;20:962–6.

    PubMed  Google Scholar 

  58. Ustinova EE, Fraser MO, Pezzone MA. Cross-talk and sensitization of bladder afferent nerves. Neurourol Urodyn. 2010;29:77–81.

    Article  PubMed  Google Scholar 

  59. Rodriguez MA, Afari N, Buchwald DS. Evidence for overlap between urological and nonurological unexplained clinical conditions. J Urol. 2009;182:2123–31.

    Article  PubMed  Google Scholar 

  60. Butrick CW, Sanford D, Hou Q, et al. Chronic pelvic pain syndromes: clinical, urodynamic, and urothelial observations. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:1047–53.

    Article  PubMed  Google Scholar 

  61. Sastry DN, Hunter KM, Whitmore KE. Urodynamic testing and interstitial cystitis/painful bladder syndrome. Int Urogynecol J Pelvic Floor Dysfunct. 2010;21:157–61.

    Article  Google Scholar 

  62. Dasgupta J, Tincello DG. Interstitial cystitis/bladder pain syndrome: an update. Maturitas. 2009;64:212–7.

    Article  PubMed  Google Scholar 

  63. Ochs RL, Stein Jr TW, Peebles CL, et al. Autoantibodies in interstitial cystitis. J Urol. 1994;151:587–92.

    PubMed  CAS  Google Scholar 

  64. Helin H, Mattila J, Rantala I, et al. In vivo binding of immunoglobulin and complement to elastic structures in urinary bladder vascular walls in interstitial cystitis: demonstration by immunoelectron microscopy. Clin Immunol Immunopathol. 1987;43:88–96.

    Article  PubMed  CAS  Google Scholar 

  65. Christmas TJ, Bottazzo GF. Abnormal urothelial HLA-DR expression in interstitial cystitis. Clin Exp Immunol. 1992;87:450–4.

    Article  PubMed  CAS  Google Scholar 

  66. Christmas TJ. Lymphocyte sub-populations in the bladder wall in normal bladder, bacterial cystitis and interstitial cystitis. Br J Urol. 1994;73:508–15.

    Article  PubMed  CAS  Google Scholar 

  67. Haarala M, Alanen A, Hietarinta M, et al. Lower urinary tract symptoms in patients with Sjogren’s syndrome and systemic lupus erythematosus. Int Urogynecol J Pelvic Floor Dysfunct. 2000;11:84–6.

    Article  PubMed  CAS  Google Scholar 

  68. Leppilahti M, Tammela TL, Huhtala H, et al. Interstitial cystitis-like urinary symptoms among patients with Sjogren’s syndrome: a population-based study in Finland. Am J Med. 2003;115:62–5.

    Article  PubMed  Google Scholar 

  69. van de Merwe JP. Interstitial cystitis and systemic autoimmune diseases. Nat Clin Pract Urol. 2007;4:484–91.

    Article  PubMed  Google Scholar 

  70. Fall M, Oberpenning F, Peeker R. Treatment of bladder pain syndrome/interstitial cystitis 2008: can we make evidence-based decisions? Eur Urol. 2008;54:65–75.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag London Limited

About this chapter

Cite this chapter

Goules, A.V., Moutsopoulos, H.M. (2011). Nephro-Urological Involvement. In: Ramos-Casals, M., Stone, J., Moutsopoulos, H. (eds) Sjögren’s Syndrome. Springer, London. https://doi.org/10.1007/978-0-85729-947-5_19

Download citation

  • DOI: https://doi.org/10.1007/978-0-85729-947-5_19

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-0-85729-946-8

  • Online ISBN: 978-0-85729-947-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics