Obstructive nephropathy as a result of retroperitoneal fibrosis

Demko, Trudy M.; Diamond, Jonathan R.; Groff, James A.

doi:10.1681/asn.v84684

Cited by 35 publications

(5 citation statements)

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“…3,4 Contrastenhanced CT is the most commonly used diagnostic tool. 5 Endoleak cannot be ruled out in our patient, since CT was done without contrast. However, gas within the aneurysm is not consistent with this diagnosis.…”

Section: Endoleakmentioning

confidence: 85%

A 74-year-old man with abdominal pain

Khan

Patel

March

et al. 2013

CCJM

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A 74-year-old man presented to the emergency department in December 2011 with a 1-week history of worsening abdominal pain, nausea with emesis, and decreased appetite. The pain was dull, diffuse, and not related to oral intake or bowel movements. He denied any bloody stools, melena, or hematemesis, but he had not had a bowel movement in the past week.He was already known to have stage IV colon cancer with metastases to the lungs and liver. He had undergone a partial colectomy in 2009 and was receiving chemotherapy at the time of admission.He also had an infrarenal abdominal aortic aneurysm that had been repaired in 2003 with endovascular placement of a Gore Excluder stent graft. This was complicated by a type II endoleak, treated with coil embolization. The same endoleak later recurred and was treated with injection of Onyx liquid embolic agent.His medical history also included hypertension, type 2 diabetes mellitus, and hyperlipidemia. He had undergone a laparoscopic cholecystectomy in 2007.He denied any fevers, chills, headache, lightheadedness, or change in vision. He had no respiratory, cardiac, or urinary symptoms. He had been constipated for the past few weeks and had recently been started on a bowel regimen, with mild relief. There had been no other changes to his medications.His temperature on presentation was 97.5˚F (36.4˚C), blood pressure 120/64 mm Hg, pulse 96, respiratory rate 22, and oxygen saturation 95% on room air. He was awake, alert, oriented, and in no acute distress. His mucous membranes were dry. His lungs were clear to auscultation, and his heart sounds were normal. His bowel sounds were hyperactive and his abdomen was slightly tender diffusely, but there was no abdominal distention, rebound tenderness, guarding, or palpable masses. His joints, muscle strength, and IM Board revIew

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Section: Endoleakmentioning

confidence: 85%

A 74-year-old man with abdominal pain

Khan

Patel

March

et al. 2013

CCJM

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“…La prevalencia estimada de la fibrosis retroperitoneal es de 0,2 a 2 casos por 100.000 3,5 , mientras que la incidencia anual es de 0,1-0,5 casos por cada 100.000 habitantes 4,6 . Hay un predomino del género masculino en la fibrosis retroperitoneal de 2-3:1 respecto a las mujeres [7][8][9] . La edad de presentación típica es en la quinta y sexta décadas de vida 1,5,7,10 .…”

Section: Discussionunclassified

“…El ceroide, un polímero insoluble de lípidos y proteínas oxidados, parece ser el antígeno blanco. De hecho, se pueden encontrar anticuerpos circulantes contra el ceroide en más del 90% de los pacientes con fibrosis retroperitoneal 3,9 . Una vez que se produce el adelgazamiento o la rotura de la media de la aorta, los antígenos son procesados por los macrófagos de la adventicia 4 .…”

Section: Fibrosis Retroperitoneal Idiopática O Primariaunclassified

“…Ello inicia la respuesta inflamatoria, con la llegada de células de defensa al área de aterosclerosis y liberación de doi: 10.5867/medwave.2013.08.5795 numerosas citocinas, factores de crecimiento y sustancias profibrinogénicas. Los macrófagos secretan factor de crecimiento fibroblástico y los linfocitos T secretan factor de crecimiento fibroblástico y factor estimulante de la síntesis de colágeno, lo que resulta en la proliferación de fibroblastos y fibrosis 9 .…”

Section: Fibrosis Retroperitoneal Idiopática O Primariaunclassified

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Retroperitoneal fibrosis: case report and literature review

Camacho¹,

Helú²,

Valenzuela³

et al. 2013

Medwave

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Introduction. The first description of extrinsic uretheral obstruction by retroperitoneal fibrosis occurred in 1905. In little more than a century, about 800 cases of this disease have been reported. Case description. We report the case of a female 55 year-old patient who presents with diffuse abdominal pain of long duration, nausea, vomiting, fever of 38°C and hypertension of 160/100 mmHg. A CT scan is performed that shows a retroperitoneal mass that obstructs the urethers. Exploratory laparotomy was performed, urethers were released and biopsy was taken. Pathology analysis showed the presence of retroperitoneal fibrosis, a rare pathological entity whose diagnosis requires a high index of suspicion based on clinical, imaging and laboratory workup. Literature review. There are no clear definitions of the variety of disorders that are included in the spectrum of retroperitoneal fibrosis, due to the rarity of this condition. Consequently, we lack diagnostic criteria and a consistent classification of the different forms that it may adopt. However, when there is suspicion of retroperitoneal fibrosis, the first step is to establish whether it is idiopathic or secondary, as there will be treatment implications. Conclusion. Retroperitoneal fibrosis should be considered in the differential diagnosis whenever diffuse abdominal pain is associated with uretheral or great vessels compression

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“…Historically, Mitchinson proposed a possible role of aortic atherosclerotic plaque and consequent chronic periaortitis as the trigger of fibroinflammatory reaction to an antigen [11]. The immune response to ceroids, a complex polymer of oxidized lipids, could induce activation of B and T lymphocytes, macrophages, plasma cells, and eosinophiles that finally produce fibrosis through cytokines environment [12, 13]. Further studies showed that IRF affected also patients without atherosclerosis and atherosclerotic plaques [14].…”

Section: Etiology and Pathogenesismentioning

confidence: 99%

Idiopathic Retroperitoneal Fibrosis: What Is the Optimal Clinical Approach for Long-Term Preservation of Renal Function?

et al. 2022

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Background: The aim of this study was to investigate the long-term effects of ureteral stenting and the exact timing of stent removal in favor of surgery in patients with idiopathic retroperitoneal fibrosis (IRF). Summary: Medline research terms of “idiopathic retroperitoneal fibrosis” AND “ medical therapy” OR “ureteral stenting” OR “surgical treatment” were done. Systematic reviews and observational and clinical studies were analyzed to obtain indication regarding the objective of the study for a narrative review. Ninety-two papers were analyzed. The treatment of IRF includes the monitoring of retroperitoneal fibrotic process spread and the prevention of abdominal organs entrapment. Treatment of ureteral obstruction includes medical therapy and ureteral stenting (US) or percutaneous nephrostomy (PNS) to overcome the worsening of renal function. Up to now, the timing of US or PNS removal is not yet clear, both for the complexity of evaluating the efficacy of the medical therapy and demonstrating the resolution of obstructive nephropathy. Moreover, it is not yet clear if the long-term ureteral stent placement or PNS is able to maintain an efficient renal function. Ureterolysis with a laparoscopic robot-assisted approach is now considered as an ultimate treatment for ureteral obstruction, limiting the progression of kidney impairment and improving the quality of life of patients, although nephrologists are generally abdicant regarding the potential switch toward the surgical approach. Key Messages: Prospective studies regarding the long-term effects of US on the renal function impairment in patients with IRF should be structured to obtain adequate information on the exact timing for the surgical approach.

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Obstructive nephropathy as a result of retroperitoneal fibrosis

Cited by 35 publications

References 0 publications

A 74-year-old man with abdominal pain

A 74-year-old man with abdominal pain

Retroperitoneal fibrosis: case report and literature review

Idiopathic Retroperitoneal Fibrosis: What Is the Optimal Clinical Approach for Long-Term Preservation of Renal Function?

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