The evaluation of patients with retroperitoneal fibrosis were followed up and treated: Dokuz Eylul university Hospital experience

OBJECTIVE: Retroperitoneal fibrosis (RPF) is a rare disease characterized by fibrosis and inflammation of the retroperitoneal tissue. The purpose of study is; to evaluate the patients with RPF who diagnosed and treated in our center retrospectively. METHODS: 25 patients with RPF diagnosed at Dokuz Eylül University Hospital between 2009 and 2017 were included in this study. Demographic characteristics, associated diseases, clinical findings, laboratory tests, imaging modalities, medical and surgical treatments were obtained retrospectively from patient files and evaluated. RESULTS: 17 of the patients were male and 8 were female. The mean age at diagnosis was 53.28 ± 13.51. The mean follow-up period was 39.16 ± 30.72 months. Patients were most commonly referred to our center with back pain (n=14; 56%). At the first evaluation of the patients; mean serum creatinine level was 2.79 ± 0.48 mg/dL, mean estimated glomerular filtration rate (eGFR) was 54.3 ± 8.54 mL/min/1.73m², mean erythrocyte sedimentation rate (ESR) was 66.17 ± 5.67 mm/h, mean C-reactive protein (CRP) level was 78.43 ± 13.85 mg/L. As an imaging method for RPF diagnosis; ultrasonography was used in 12 patients (48%), computerized tomography in 20 patients (80%), magnetic resonance imaging in 6 patients (24%), positron emission tomography in 9 patients (36%). The most commonly used medical treatment was the combination of methylprednisolone and azathioprine (n=20; 83.3%). 14 patients were inserted double J stents, 9 of them were bilaterally. After treatment; mean serum creatinine level was 1.00 ± 0.15 mg/dL, mean eGFR was 88.33 ± 4.84 mL/min/1.73m², mean ESR was 16.98 ± 1.9 mm/h, mean serum CRP was 4.85 ± 1.43 mg/L. A statistically significant difference was observed between baseline and follow-up variables including serum creatinine (p<0.05), eGFR (p<0.05) , serum CRP (p<0.05), ESR (p<0.05), and haemoglobin (p<0.05). 4 patients (16%) underwent renal replacement therapy. CONCLUSION: RPF is a rare disease that requires a multidisciplinary approach. Clinical remission can be achieved with the use of corticosteroids and azathioprine. No regression in mass size does not always mean unresponsiveness to treatment. The fibrotic mass may not reduce with treatment. KEY WORDS: Retroperitoneal Fibrosis, Creatinine, Methylprednisolone, Azathioprine