Clinical manifestations and diagnosis of retroperitoneal fibrosis
- Augusto Vaglio, MD, PhD
Augusto Vaglio, MD, PhD
- University Hospital, Parma, Italy
- Alessandra Palmisano, MD, PhD
Alessandra Palmisano, MD, PhD
- Department of Clinical and Experimental Medicine
- University of Parma, Italy
Retroperitoneal fibrosis is a rare condition characterized by the presence of inflammatory and fibrous retroperitoneal tissue that often encases the ureters or abdominal organs . This disorder was initially called Ormond's disease , but it has also been referred to as periureteritis fibrosa, periureteritis plastica, chronic periureteritis, sclerosing retroperitoneal granuloma, and fibrous retroperitonitis.
Retroperitoneal fibrosis may be idiopathic or secondary to other causes. Idiopathic retroperitoneal fibrosis is an immune-mediated disease, which can be either isolated, associated with other autoimmune diseases, or arise in the context of a multifocal fibroinflammatory disorder, named immunoglobulin G4-related disease (IgG4-RD). Although there are no standardized criteria of classification, idiopathic retroperitoneal fibrosis is actually part of the disease spectrum of chronic periaortitis, a condition characterized by inflammation and fibrosis surrounding the aorta and iliac arteries [1,3,4]. Chronic periaortitis includes inflammatory abdominal aortic aneurysms and perianeurysmal retroperitoneal fibrosis, two entities that are grouped together because of similar clinical and histologic characteristics, although pathogeneses and epidemiology may differ . It has also been proposed that chronic periaortitis is a form of large-vessel vasculitis, especially in cases that also show thoracic aorta involvement .
The etiology, pathogenesis, clinical manifestations, and diagnostic evaluation of retroperitoneal fibrosis will be reviewed here. The treatment of retroperitoneal fibrosis is presented separately (see "Treatment of retroperitoneal fibrosis"). Other causes of urinary tract obstruction and hydronephrosis are also reviewed elsewhere. (See "Clinical manifestations and diagnosis of urinary tract obstruction and hydronephrosis".)
Retroperitoneal fibrosis is a rare disease. In one Finnish study, the incidence of the idiopathic form of the disease was estimated from hospital discharge data to be 0.1 per 100,000 person-years and its prevalence 1.4 per 100,000 inhabitants . However, in a subsequent population-based study performed in the Netherlands, the reported annual incidence was approximately 10-fold higher (ie, 1.3 per 100,000 inhabitants per year) . The latter study probably provides a more accurate estimate of the incidence given the complexity of the diagnosis and requirement for prolonged follow-up that would not have been possible in a study of hospital discharge codes .
Idiopathic disease most commonly occurs in individuals 40 to 60 years of age [5,8,10,11]. Most studies have suggested a 2 to 3:1 male-to-female predominance [5,8,10,11], although this is not reported in all studies . One study has suggested that chronic periaortitis, which includes idiopathic retroperitoneal fibrosis, is associated with the human leukocyte antigen (HLA) allele HLA-DRB1 03 .
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- ETIOLOGY AND RISK FACTORS
- CLINICAL FEATURES
- Clinical manifestations
- Laboratory findings
- Computed tomography scan
- Other diagnostic tests
- - Magnetic resonance imaging
- - Intravenous urography
- - Retrograde or percutaneous antegrade pyelography
- DIFFERENTIAL DIAGNOSIS
- EVALUATION AFTER DIAGNOSIS
- MONITORING DISEASE ACTIVITY
- Positron emission tomography