Retroperitoneal Fibrosis Follow-up

Updated: Jul 31, 2016
  • Author: Chandra Shekhar Biyani, MS, MBBS, DUrol, FRCS(Urol), FEBU; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Follow-up

Further Outpatient Care

Biochemical markers (eg, C-reactive protein, erythrocyte sedimentation rate, renal function) should be monitored every 4-8 weeks to assess the response.

Radiologic assessment (eg, CT scanning, MRI) is performed every 3 months. Once disease is stabilized, scanning can be repeated at 6 months.

Recurrence of stenosis has been reported as late as 10 years; thus, long-term follow-up is necessary.

Patients with renal failure should be referred to a nephrologist early in the course of their disease and have continued nephrologic follow-up. Renal recovery is usually observed within the first 2 weeks, but some patients may not regain renal function until much later.

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Further Inpatient Care

After relief of long-standing obstruction, a physiologic diuresis is expected. This is usually a self-limiting process and can be managed conservatively with fluid and electrolyte replacement.

Urea diuresis is the most common. It is self-limiting, lasting 24-48 hours. Monitoring of fluid balance and electrolytes is required. Unless otherwise contraindicated, increased oral fluid intake should suffice.

Sodium diuresis is the second most common postobstructive diuresis. It usually is self-limiting but may have a longer duration (>72 h). Monitor fluid balance and electrolytes more aggressively (ie, intake and output [I/O], central venous pressure [CVP], urine and serum electrolytes).

Ultrasonography may be used to assess hydronephrosis.

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Complications

See the list below:

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Prognosis

The natural history of retroperitoneal fibrosis (RPF) has not been clearly established. However, the outcome of nonmalignant retroperitoneal fibrosis is generally good. [67, 68, 69, 70, 71, 72, 73, 74] Renal recovery is usually observed within the first 2 weeks. Checking these patients periodically is always better because some patients may regain renal function much later. The prognosis of malignant retroperitoneal fibrosis is poor.

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Patient Education

Patients with renal failure should be educated about the following:

  • The importance of compliance with secondary preventative measures
  • Natural disease progression
  • Prescribed medications (highlighting their potential benefits and adverse effects)
  • Diet
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