Silent Kidney Failure and Endometriosis

Endometriosis is commonly a gynecologic condition, mostly found in the pelvic area. Deep infiltrative endometriosis is found deep within the tissue or organs and can affect surrounding organs such as the bowel and the bladder. Deep infiltrating endometriosis is rare, and affects somewhere between 1% to 5% of women with the disease.¹

How endometriosis affects the kidneys

The kidneys can be impacted when one or both of the ureters become affected by endometriosis. The ureters transport urine from the kidneys to the bladder which stores urine. The section of the ureter that is usually affected sits below the pelvic area.¹ The involvement of the urinary tract system is uncommon and found in about 1% of endometriosis cases.²

Ureteral endometriosis can be limited to one ureter, usually the left side because of the proximity of the left ureter to the reproductive organs.

Endometriosis on the ureter can lead to a urinary tract blockage; Over time, hydronephrosis occurs, which is where the kidney becomes enlarged due to urine failing to drain correctly from the kidneys, and finally, the left kidney may lose function over time.¹

Possible symptoms

In most instances, there are no symptoms relating to urinary system involvement.² There are often non-specific symptoms, such as pelvic pain, which is typical of endometriosis.²

About 33% of patients will experience some symptoms such as urgency and frequency to urinate and/orpain around the flank or kidney area which is located at the back, in the middle of the trunk. Some women may experience blood in their urine or painful urination.²

Testing and treatment

Deep infiltrating endometriosis is more challenging to treat because it’s less receptive to hormonal treatments such as the oral contraceptive pill.¹

Diagnosis of ureteral endometriosis is most often left up to doctors who suspect urinary system involvement based on symptoms.² If there is evidence of deep infiltrative endometriosis then imaging is used such as pelvic ultrasound, intravenous pyelogram (which is a type of x-ray that uses a special dye or contrast agent), computed tomography (CT) scan, or magnetic resonance imaging (MRI) to help with diagnosis.²

In terms of treatment, laparoscopy is the gold standard for treating endometriosis surgically.

In cases of ureter involvement, the surgeon may try to free it from adhesions to take away pressure causing the blockage, through a procedure known as a ureterolysis. Or the lower part of the ureter may be removed and re-implanted into the bladder, which is known as a ureterectomy. Another procedure called a ureteroureterostomy may be performed which connects two of the ureters to allow urine to drain from the kidneys properly.²

The procedure is often done through laparoscopic (or "keyhole surgery") or through robotic surgery where the surgeon uses a computer to control robotic arms which moves instruments to help perform the operation.

Taking care of your kidney health

The good news is if one kidney isn’t functioning you can survive on the other kidney.³ So if you find out you only have one fully-functioning kidney, you’ll want to look after it! Here are some ways you can take care of your kidney:

Get a yearly check up with your doctor to check your kidney health. Some important checks are glomerular filtration rate (GFR) and your blood pressure.³

• Reduce your salt intake and eat a healthy diet rich in whole foods such as fruit and vegetables
• Don’t smoke
• Exercise regularly
• Limit your alcohol intake
• Reduce stress
• Keep your cholesterol levels healthy
• Maintain a healthy body weight