Steroid Therapy For Idiopathic Retroperitoneal Fibrosis: Dose And Duration

Kardar, Abdul Hafeez; Kattan, Said; Lindstedt, E; Hanash, Kamal A.

doi:10.1016/s0022-5347(05)64677-0

Cited by 135 publications

(79 citation statements)

References 19 publications

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“…Steroids are usually effective in chronic periaortitis and induce remission of the clinical symptoms, normalization of the acutephase reaction, reduction in size of the retroperitoneal mass and also resolution of the obstructive complications [9,10]. Several different immunosuppressive drugs have been used as steroid-sparing agents or in patients not responding to steroids alone or when steroids cannot be tapered.…”

Section: Discussionmentioning

confidence: 99%

Isolated periaortitis in a 53-year-old male

Nambiar¹,

Kannoth²,

Dae³

2017

J Med Therap

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Chronic periaortitis includes a specific group of rare diseases which is characterized by the presence of abnormal fibroinflammatory tissue in the periaortic retroperitoneum. We describe a case of nonaneurysmal form of chronic periaortitis, recognized as isolated periaortitis, in a male patient who presented with low back pain. We report this case to highlight the fact that periaortitis can present as an isolated primary condition and can be reported without aortic aneurysm or retroperitoneal fibrosis. Case reportA 53-year-old male presented with low backache of 3 month's duration. The pain was of moderate intensity, unaffected by motion, and not relieved by bed-rest. He had lost approximately nine kilograms over the last 6 months. He did not give any history of fever. Physical examination revealed blood pressure of 200/110 mm Hg in upper limbs and 180/110 mm Hg in both lower limbs. The remainder of physical examination was essentially normal. Blood investigations revealed elevated erythrocyte sedimentation rate of 130 mm and elevated C-reactive protein. Renal and liver function tests were essentially normal. Autoimmune (ANA, ANCA) and infectious work-up (serological testing for syphilis) were negative. Chest and lumbar spine radiographs were normal. A computerized tomography (CT) scan of the lumbar spine was undertaken to exclude any inflammatory process which showed retroperitoneal soft tissue thickening. Hence, CT angiography of aorta (Figure 1) was done which revealed extensive abdominal aortic thickening without any abnormal dilatation. In addition, there was a retroperitoneal concentric periaortic soft tissue mass (rind of periaortic tissue) causing luminal narrowing of the abdominal aorta and significant ostial stenosis of the left renal artery. Infectious workup for vasculitis was also negative. There was no ureteric obstruction or hydronephrosis. This presentation was consistent with the diagnosis of isolated periaortitis confined to abdominal aorta. He was started on antihypertensives and steroids (prednisone 60 mg daily). On follow-up after 12 months, his blood pressure was controlled (130/80 mm Hg). Repeated CT scans showed progressive resolution of the periaortic rind with no evidence of abdominal aorta aneurysm.

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Section: Discussionmentioning

confidence: 99%

Isolated periaortitis in a 53-year-old male

Nambiar¹,

Kannoth²,

Dae³

2017

J Med Therap

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“…Thereafter, patients are started on a course of steroid therapy. Multiple regimens exist but we prefer high dose steroids for the first 2 months followed by serially lower doses as delineated by Kardar and colleagues [6]. This will eventually obviate the need for chronic ureteral stenting if successful.…”

Section: Discussionmentioning

confidence: 99%

U-shaped Bilateral Ileal Ureter Substitution for Failed Conservative Management of Retroperitoneal Fibrosis: A Case Report

Chen

Ylitalo²,

Santucci³

2013

Med Surg Urol

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“…Steroids are effective in prompt improvement of symptoms within a few days with a fall in ESR as well (27). It also causes a reduction of retroperitoneal mass and a resolution of obstructive uropathy (29). However, some authors are reluctant to use steroids as primary therapy before performing an open or laparoscopic biopsy to exclude malignant RPF (23).…”

Section: Pharmacotherapymentioning

confidence: 99%