Huang Zixiong, Liu Yanying, Xiao Yunshu, Hu Hao, Xu Tao
Department of Urology, Peking University People's Hospital, Beijing, 100044, People's Republic of China.
Applied Lithotripsy Institute, Peking University, Beijing, 100044, People's Republic of China.
Int J Gen Med. 2025 Jan 9;18:113-121. doi: 10.2147/IJGM.S490245. eCollection 2025.
This study investigated the efficacy of comprehensive management and predictable inflammatory markers for idiopathic retroperitoneal fibrosis (iRPF)-related hydronephrosis outcomes.
Patients with iRPF-related hydronephrosis underwent surgical (ureteral stent and/or nephrostomy tube placement) and medical (corticosteroid-based multiple immunosuppressants) management were classified according to stent-indwelling outcomes. Univariate analysis of clinical profiles was conducted to screen possible predictors of hydronephrosis remission.
In a series of 38 patients, 52.6% achieved hydronephrosis remission and stent/tube removal (stent-free group). The median indwelling time in the stent-free group (12 months) was significantly lower than that in the treatment-failure group (37 months, <0.05). Mean retroperitoneal mass diameters was significantly reduced (anteroposterior by 11.66 mm (95% CI 2.31-21.01), transverse by 15.41 mm (95% CI 3.37-27.46), suprainferior by 30.53 mm (95% CI 4.87-56.19); <0.05) during the treatment course, in line with mean renal pelvis width (by 36.2%) and renal function parameters (serum creatinine by 16.9%, blood urea nitrogen by 12.9%). Renal function improved (36.9%) or remained stable (44.7%) in most patients, the mean estimated glomerular filtration rate increasing by 8.7% (from 55.4 mL/min/1.73 m to 60.2 mL/min/1.73 m). At the initial diagnosis, median serum immunoglobulin IgG and CRP levels were significantly higher in the stent-free group than in the treatment-failure group (IgG 17.55 g/L vs. 13.50 g/L, CRP 19.60 mg/L vs. 3.15 mg/L; <0.05). Decline in serum IgG (-5.80 g/L vs. -2.30 g/L), CRP (-18.93 mg/L vs. -1.72 mg/L) and erythrocyte sedimentation rate (-22.00 mm/h vs. -1.50 mm/h) levels in the stent-free group surpassed those in the treatment-failure group (<0.05).
Comprehensive management benefits iRPF patients with hydronephrosis by preserving renal function. The 24-month scale might guide stent/tube removal. Elevated inflammatory markers (IgG and CRP) at the initial iRPF diagnosis and IgG, CRP, and erythrocyte sedimentationrate (ESR) variations associated with hydronephrosis outcomes.
本研究探讨综合治疗及可预测的炎症标志物对特发性腹膜后纤维化（iRPF）相关肾积水治疗效果的影响。
对接受手术（输尿管支架置入和/或肾造瘘管置入）及药物（基于皮质类固醇的多种免疫抑制剂）治疗的iRPF相关肾积水患者，根据支架留置结果进行分类。对临床资料进行单因素分析，以筛选肾积水缓解的可能预测因素。
在38例患者中，52.6%实现了肾积水缓解并拔除支架/导管（无支架组）。无支架组的中位留置时间（12个月）显著低于治疗失败组（37个月，<0.05）。在治疗过程中，腹膜后肿块平均直径显著减小（前后径减小11.66 mm（95%CI 2.31 - 21.01），横径减小15.41 mm（95%CI 3.37 - 27.46），上下径减小30.53 mm（95%CI 4.87 - 56.19）；<0.05），这与肾盂平均宽度（减小36.2%）和肾功能参数（血清肌酐降低16.9%，血尿素氮降低12.9%）一致。大多数患者肾功能改善（36.9%）或保持稳定（44.7%），平均估计肾小球滤过率增加8.7%（从55.4 mL/min/1.73 m²增至60.2 mL/min/1.73 m²）。在初始诊断时，无支架组的血清免疫球蛋白IgG和CRP水平中位数显著高于治疗失败组（IgG 17.55 g/L对13.50 g/L，CRP 19.60 mg/L对3.15 mg/L；<0.05）。无支架组血清IgG（-5.80 g/L对-2.30 g/L）、CRP（-18.93 mg/L对- .72 mg/L）和红细胞沉降率（-22.00 mm/h对-1.50 mm/h）水平的下降超过治疗失败组（<0.05）。
综合治疗通过保护肾功能使iRPF相关肾积水患者受益。24个月的时间尺度可能指导支架/导管的拔除。iRPF初始诊断时炎症标志物（IgG和CRP）升高以及IgG、CRP和红细胞沉降率（ESR）变化与肾积水治疗效果相关。
