Like so many other places in the body, the genitourinary
tract of MCAS patients can easily become inflamed. Many patients, especially women, are treated
for chronic urinary tract infections despite negative cultures. Male MCAS patients are often diagnosed with
prostatitis. Vaginal inflammation, painful inflammation,
and vulvodynia/ vulvar vestibulitis are also found frequently in mast cell
patients. (Please see previous post on
vaginal pain in chronic disease.)
Mast cells are not often found in healthy renal tissue, but
they are frequently present in various types of renal disease. They are most commonly associated with
tubulointerstitial nephritis associated with fibrosis and renal failure,
including glomerulonephritis, diabetic nephropathy, allograft rejection,
amyloid disease, polycystic kidney disease, reflux nephropathy and others. Mast cells drive fibrosis and their presence
correlates with decrease in glomerular filtration and a poor prognosis.
MCAS patients with urinary pain often suffer from
obstructive ureteral angioedema, swelling of the urethra that prevents the urine
from passing through it. Persistent
lower back pain is common, with flank pain and lower abdominal quadrant pain
being less common.
Fertility issues are not rare in mast cell patients. Luteinizing hormone activates mast cells,
which release histamine to stimulate ovarian contractility, ovulation and
progesterone release by follicles. Histamine
is necessary for these functions and antihistamines can prevent ovulation. Frequent miscarriage should not be readily
attributed to mast cell disease.
Antiphospholipid antibodies should be considered.
Mast cell degranulation has been implicated in testicular
sclerosis via production of 15d-prostaglandin J2. Mast cell stabilizers can help treat
oligospermia significantly enough to result in pregnancy. Decreased libido and erectile dysfunction is
common in mast cell disease, including MCAS.
15-20% of women in childbearing years have
endometriosis. Endometriosis is the occurrence
of endometrial tissue outside of its normal location. In these patients, endometrial tissue is
often found in the peritoneum. These
ectopic tissues are often fibrosis and cause significant inflammation.
Mast cells are significantly increased in endometrial lesions,
with 89% showing significant activation in regions that stain heavily for CRH
and urocortin. Mast cells in normal and
proliferative endometrium are not activated.
Additionally, IL-1a, IL-6 and TNFa, among other inflammatory mast cell mediators,
are increased in the tissue and fluids surrounding endometrial lesions. (A detailed post on this is coming soon.)
Interstitial cystitis is often misdiagnosed as
endometriosis. In IC, urinary urgency,
increased urinary frequency, suprapubic and pelvic pain and pain on intercourse
are the most common symptoms. IC is caused
by increased mast cells in the bladder. In
IC patients, 146 mast cells were found over 10 high power fields; in patients
with bacterial bladder infections, 97 were found; and in health controls, 51
were found. (A detailed post on this is
also coming.)
References:
Sant, Grannum R., Kempuraj , Duraisamy, Marchand , James E.,
Theoharides, Theoharis C. The mast cell
in interstitial cystitis: role in pathophysiology and pathogenesis. 2007.
Urology 69 (Suppl 4A): 34-40.
Holdsworth SR, Summers SA.
Role of mast cells in progressive renal disease. J. Am. Soc. Nephrol. 2008 Dec;
19(12):2254-2261.
Kempuraj D, Theoharides
TC, et al. Increased numbers of
activated mast cells in endometrial lesions positive for
corticotropin-releasing hormone and urocortin.
Am. J. Reprod. Immunol. 2004; 52:267-275.
Afrin, Lawrence B. Presentation, diagnosis and management of
mast cell activation syndrome.
2013. Mast cells.
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