SUMMARY
A florid case of retroperitoneal fibrosis with severe vascular as well as urinary complications is described.
The ætiology is discussed and from a study of the available literature it is concluded that the basic disorder is a vasculitis with similarities to polyarteritis nodosa or the necrotising arteritis of Wegener.
Widespread general effects, notably obscure pain, anorexia, and weight loss may precede, by months or years, the more overt ureteric obstructive manifestations: joint symptoms, pericarditis, and respiratory infection may also occur.
Obstruction of the inferior vena cava and arterial insufficiency may develop.
A raised sedimentation rate is an index of activity. Serum protein changes are non‐specific. Anaemia may be an early manifestation.
There is evidence that the connective tissue changes may be widespread and even involve the mediastinum.
There is a tendency towards eventual self‐limitation of the disease.
Ureterolysis is an efficient method for treatment of the functional obstruction of the ureters and steroid therapy may be of help.
SUMMARY
Three examples of metastatic malignant, functional, post‐renal anuria are presented. They occurred in patients with tumours of the breast, stomach, and pancreas respectively. In all there was widespread metastatic malignant infiltration of the retroperitoneal tissue, particularly in the region of the ureters.
Mechanical obstruction of the ureters was excluded during life by the free passage of retrograde ureteric catheters and at autopsy by the passage of probes.
Iliac and para‐aortic lymph node metastases were present but were not responsible for the ureteric obstruction.
The aetiology of the post‐renal oliguria and anuria was obscure, but previous studies by other writers suggest that ureteric peristalsis was impaired by the presence of ureteric or peri‐ureteric infiltration.
An analogy is drawn between the functional effects produced by metastatic malignant retroperitoneal infiltration and idiopathic retroperitoneal fibrosis: differential diagnosis may require surgical exploration and biopsy of the peri‐ureteric tissues or a portion of the ureter itself.
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