Department of Urology, The First Affiliated Hospital of Zhengzhou University, 450000 Zhengzhou, Henan, China.
Department of Clinical Medicine, Medical College of Zhengzhou University, 450000 Zhengzhou, Henan, China.
Arch Esp Urol. 2024 Aug;77(7):818-825. doi: 10.56434/j.arch.esp.urol.20247707.114.
Retroperitoneal fibrosis is a rare disease characterized by chronic inflammation and fibrosis in the retroperitoneal space that may wrap around the ureter and cause an obstruction. Here we present the cases of three patients diagnosed and treated between April and August 2022.
Here we present three cases of retroperitoneal fibrosis. Imaging revealed hydronephrosis and/or ureteral dilation, whereas laboratory findings such as erythrocyte sedimentation rate, C-reactive protein, and immunoglobulin G4 were abnormal. Serum creatinine and blood urea nitrogen levels suggested renal injury. Additionally, two patients had unclear diagnoses from other hospitals. Later, all patients underwent ureteral stenting and laparoscopic ureterolysis at our hospital and simultaneous diagnosis by biopsy. The two patients with high immunoglobulin G4 levels exhibited extremely severe fibrosis. After discharge, each received maintenance prednisone to prevent recurrence as well as methotrexate, followed by follow-up every 3 months. Fortunately, serum creatinine, blood urea nitrogen, and intravenous urography findings remained normal with an average follow-up of 8.5 months.
Here we discovered interesting findings in the diagnosis and treatment of retroperitoneal fibrosis, including the stable effect of medical plus surgical treatment, an unclear ureteral obstruction etiology, and the relationship between immunoglobulin G4 level and fibrosis hardness. However, the mechanisms behind these new findings require further study.
腹膜后纤维化是一种罕见疾病，其特征为腹膜后腔的慢性炎症和纤维化，可能会围绕输尿管并导致梗阻。本文报告了 2022 年 4 月至 8 月期间诊断和治疗的 3 例患者的病例。
本文报告了 3 例腹膜后纤维化患者。影像学检查显示存在肾盂积水和/或输尿管扩张，而红细胞沉降率、C 反应蛋白和免疫球蛋白 G4 等实验室检查结果异常。血清肌酐和血尿素氮水平提示存在肾损伤。此外，2 例患者在其他医院的诊断不明确。后来，所有患者均在我院接受输尿管支架置入和腹腔镜输尿管松解术，并同时进行活检以明确诊断。2 例免疫球蛋白 G4 水平较高的患者表现出极其严重的纤维化。出院后，每位患者均接受维持性泼尼松治疗以预防复发，并接受甲氨蝶呤治疗，随后每 3 个月进行一次随访。幸运的是，血清肌酐、血尿素氮和静脉尿路造影检查结果均正常，平均随访时间为 8.5 个月。
本文在腹膜后纤维化的诊断和治疗方面发现了一些有趣的发现，包括药物联合手术治疗的稳定效果、输尿管梗阻病因不明确以及免疫球蛋白 G4 水平与纤维化硬度之间的关系。然而，这些新发现背后的机制仍需要进一步研究。
