Retroperitoneal Fibrosis: Still a Diagnostic Challenge

Abstract

Retroperitoneal fibrosis (RPF) is a rare fibroinflammatory disorder usually involving the abdominal aorta and surrounding structures. It is divided into primary (idiopathic) and secondary RPF. Primary RPF can be immunoglobulin (Ig) G4-related disease or non-IgG4-related disease. Recently, there has been a rise in case reports regarding the topic, but awareness about the disease is still far from ideal. Hence, we present the case of a 49-year-old female who had repeated admissions for chronic abdominal pain attributed to chronic alcoholic pancreatitis. She had a medical history significant for psoriasis and surgical history significant for cholecystectomy. Her computed tomography (CT) scans on each admission for the last year showed some signs of RPF, but it was never considered the primary etiology of her chronic symptoms. We also obtained magnetic resonance imaging (MRI) which did not show any underlying malignancy but showed the progression of her RPF. She was started on a steroid regimen, which significantly improved her symptoms. She was diagnosed with idiopathic RPF due to unclear etiology, although her underlying risk factors, including psoriasis, past surgeries, and pancreatitis-associated inflammation, were considered predisposing factors. Idiopathic RPF accounts for more than two-thirds of total cases of RPF. Patients with autoimmune diseases can overlap with other autoimmune disorders. For non-malignant RPF, medical management with 1mg/kg/day steroids is deemed effective. Still, there is a lack of prospective trials and consensus for guidelines on treating RPF. The follow-up involves laboratory tests, including erythrocyte sedimentation rate, C-reactive protein, and CT or MRI in an outpatient setting to identify treatment response and relapse. There is a need for more streamlined guidelines to diagnose and manage this disease.

Uranium Translocation From Water Soil and Rock System to Various Plants and Their Components

“…The accumulation of uranium has a signi cant impact on the germination, early growth of seedlings, photosynthesis, and metabolic and physiological functions of plants. [5]Geochemical processes, absorption and movement inside plants, harmful effects on plants, entry into the food chain, and ultimately, in uence on human well-being. Furthermore, alterations in the physico-chemical characteristics of soil and groundwater resulting from land use practices and shifts in climatic conditions after few decades also impact the presence of uranium in the terrestrial environment.[6-8].…”

Is a Biopsy Required to Classify Patients with Idiopathic Retroperitoneal Fibrosis as IgG4-RPF or Non-IgG4-RPF?

“…About 75 % of RPF cases are primary (idiopathic RPF) and about 25 % are secondary cases associated with conditions such as malignancies, infections, drugs and radiotherapy [2]. Idio pathic RPF cases (IRPF) include both those associated with immu noglobulin (Ig) G4-related disease (IgG4-RD) (IgG4-RPF) and those not associated with IgG4-RD (non-IgG4-RPF) [4]. The median age at onset of IRPF is 55-60 years, it is more common in males (M/F: 2-3/1) and has an estimated prevalence of 1.4/100,000 [5].…”