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Saudi Journal of Kidney Diseases and Transplantation
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CASE REPORT Table of Contents   
Year : 2005  |  Volume : 16  |  Issue : 1  |  Page : 78-80
Idiopathic Retroperitoneal Fibrosis Revealed by Renal Colic


1 Department of Nephrology, Constantine Military Hospital, Constantine – Algeria
2 Division of Nephrology, Department of Medicine, Vaudois University Hospital, Lausanne, Swaziland

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   Abstract 

Retroperitoneal fibrosis is an uncommon disease that can be defined as the presence of a fibrous mass, which surrounds vascular structures and ureters. The start of the disease is insidious but can be diagnosed by radiological means such as computerized tomography and magnetic resonance imaging. Steroids and immunosuppressive agents may prevent progression toward advanced renal failure. We report a case of 41-year-old man who presented with bilateral renal colic as the only clinical manifestation of this disease and its favorable response to treatment.

Keywords: Retroperitoneal fibrosis, Renal colic, Renal failure, Ureteral obstruction, Steroids.

How to cite this article:
Bouhabel A, Takoucht F, Meier P. Idiopathic Retroperitoneal Fibrosis Revealed by Renal Colic. Saudi J Kidney Dis Transpl 2005;16:78-80

How to cite this URL:
Bouhabel A, Takoucht F, Meier P. Idiopathic Retroperitoneal Fibrosis Revealed by Renal Colic. Saudi J Kidney Dis Transpl [serial online] 2005 [cited 2019 Sep 16];16:78-80. Available from: http://www.sjkdt.org/text.asp?2005/16/1/78/32953

   Introduction Top


Retroperitoneal fibrosis is an uncommon disease that can be defined as the presence of a fibrous mass, which surrounds vascular stru­ctures and ureters. [1],[2],[3],[4],[5] The start of the disease is insidious but can be diagnosed by radiological means such as computerized tomography and magnetic resonance imaging. Steroids and immunosuppressive agents may prevent progression toward advanced renal failure. [2],[5]


   Case Report Top


41-year-old man presented to the emergency room at our hospital with bilateral renal colic. He had this abdominal pain with loss of weight for six months and has been managed as a case of spastic colon syndrome

The laboratory investigations showed: blood urea nitrogen 30 mmol/l, serum creatinine 700 µmol/l, potassium 7 mmol/l and hemoglobin 80g/l. The retrograde ureteropyelography was inconclusive, but the magnetic resonance imaging revealed an expanded retroperito­neal fibrosis and hydronephrosis, [Figure - 1]. We could not find any etiology for this fibrosis and concluded that the patient had idiopathic retroperitoneal fibrosis.

During his hospitalization, the patient required dialysis 15 times. We administered 7.5 mg/kg bolus intravenous methyl prednisolone followed by oral steroids 1 mg/kg of prednisone daily. The response to steroids was dramatic. The patient diuresed and the renal function was restored without the need for ureteral drainage or further dialysis.

After 12 months of therapy, the patient still maintains normal renal function and the markers of inflammation such as the blood sedimentation rate and C- reactive protein remain normal. Ultrasonography showed resolution of the hydronephrosis. However, the magnetic resonance imaging demonstrated persistence of the fibrosis but to a lesser degree than before treatment. The patient will remain on steroids for another year with regular monitoring.


   Discussion Top


Retroperitoneal fibrosis is a chronic infla­mmatory disease that was described first by Albaran in 1905. It is an uncommon disease with estimated incidence of 1/200,000. The incidence is higher in the autopsy series and is estimated to be1/10,000. [1],[6]

The etiology of this disease is still unknown and presents with vague abdominal complaints. The disease progresses to renal failure secon­dary to urinary obstruction.

Steroids appear to be effective in the treat­ment of this disease and the duration of the treatment is between six to twelve months, and can be continued up to two years. [2],[5],[7] More­ over, long-term follow-up is recommended because of the possible relapse of inflammation and fibrosis. [8] The response in our patient was favorable with regression of the urinary obstruction. Immunosuppressive agents can be administered in case of resistance to steroids. [2],[5],[9]

Surgical intervention is indicated in cases of abdominal aortic aneurysms associated with the disease. [3],[5]

We conclude that idiopathic retroperitoneal fibrosis is a chronic inflammatory disease. Its diagnosis is frequently late because of the insidious nature of the disease. Steroids are efficient in many cases. However, long-term monitoring is mandatory because of the possible late relapses.

 
   References Top

1.Meier P, Gilabert C, Burnier M, Blanc E. Retroperitoneal fibrosis an unrecognized inflammatory disease. Clinical obstruction and review of the literature. Nephrology 2003;24(4):173-80.  Back to cited text no. 1    
2.Kardar AH, Kattan S, Lindsted E, Hanash K. Steroids therapy for idiopathic fibrosis: dose and duration. Urol 2002;168:550-5.  Back to cited text no. 2    
3.Keith DS, Larson TS. Idiopathic retroperi­toneal fibrosis. J Am Soc Nephrol 1993;3: 1748-52.  Back to cited text no. 3  [PUBMED]  
4.Lepor H, Walch PC. Idiopathic retroperi­toneal fibrosis. J Urol 1979:122:1-6.  Back to cited text no. 4    
5.Wagneknecht LV, Hardy JC. Value of various treatments of retroperitoneal fibrosis. EUR Urol 1981;7:193-5.  Back to cited text no. 5    
6.Cotsamire D, Ibrahim G, Robertson C. Clinical parameters and therapeutic outcome in patient with idiopathic retro­peritoneal fibrosis. Arthritis Rheum 1991; 34:R34-8.  Back to cited text no. 6    
7.Arap S, Denes FT, Menzesde Goes GM. Steroids therapy in idiopathic retroperi­toneal fibrosis: report of two successful cases. Eur Urol 1985;11:352-4.  Back to cited text no. 7    
8.Tiptaft RC, Costello AJ, Paris AM, Blandy JP. The long term follow-up of idiopathic retroperitoneal fibrosis. Br J Urol 1982; 54:620-3.  Back to cited text no. 8  [PUBMED]  
9.Shirota S, Tsuchiya K, Takada M, et al. Retroperitoneal fibrosis associated with membranous nephropathy effectively treated with steroids. Intern Med 2002; 41(1):20-5.  Back to cited text no. 9    

Top
Correspondence Address:
Abdelouahab Bouhabel
Constantine Military Hospital, 13, Rue Saighi Ahmed SMK, Constantine - Algeria

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PMID: 18209461

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    Abstract
    Introduction
    Case Report
    Discussion
    References
    Article Figures
 

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