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.