Retroperitoneal Fibrosis: Current Concepts

• 24 Mar 2021 10:54:52 AM
• |General Urology

Dear All,

I am providing some materials from Newer articles on the subject on Retroperitoneal Fibrosis.

This condition was first described by Joachim Albarran in 1905 but it was rediscovered by John Kelso Ormond in 1948 (English language) and his name is attributed to this condition. Suddenly there is a spurt in our understanding of the subject. Hitherto, we managed this condition, though not frequent, when found to be obstructive, by various techniques of Ureterolysis. This has changed in recent times to predominantly Medical Management and ureterolysis is performed only in those Medical Treatment was found ineffective. Though occasionally RPF could be secondary to Malignant Infiltration, it is more often called Idiopathic as the cause of RPF was not known. But recent studies have identified several causes including IgG4 Disease as responsible for RPF.

In the past during the period where IVU was the predominant Investigation, Medial Displacement of Ureter/s was the main Diagnostic Criteria with quite often depicting Back pressure changes of PCS and Ureter with varying renal functional deterioration. But we did see many medially displaced Ureter/s without such features. Filarial Retroperitoneal Lymphangitis was common condition in the past and this was mostly due to Filarial Infection in India. Many of these patients presented with Pain akin to Ureteric Colic with IVU showing Medial Displacement of Ureter/s. There could be evidence of Obstruction (though not frequent). The way we differentiated Filarial Lymphangitis of retroperitoneum with Idiopathic RPF was by introducing an Ureteric catheter. If displacement persisted, it was more often due to Idiopathic RPF while in most instances, the ureteric displacement gets normalized in Retroperitoneal Lymphangitis (this aspect is not considered in the current literature and what is mentioned is out of personal experience).

I am providing few articles of recent origin addressing Idiopathic RPF which should give you the current scenario. If the links do not open, I could provide the full articles from my Collection.

https://pubs.rsna.org/doi/pdf/10.1148/rg.332125085

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5149574/pdf/RU-54-28715.pdf

https://link.springer.com/content/pdf/10.1007/s11255-017-1608-9.pdf

https://bjui-journals.onlinelibrary.wiley.com/doi/epdf/10.1111/bju.13915 (PDF available)

https://link.springer.com/content/pdf/10.1007/s00261-017-1282-5.pdf

https://www.ncbi.nlm.nih.gov/books/NBK482409/ (Cannot Download)

I am also providing the PDF of two articles, 1. published in ‘Urology’ Published online on March 11^th on ‘RPF Idiopathic Urological approach including Medical Management’ and 2. ‘RPF Idiopathic Long Term Risk factors and Predictors of Relapse, 2019, published in ‘American Journal of Kidney Diseases’.

With warm Regards,

Venu

 

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