Retroperitoneal fibrosis

Retroperitoneal fibrosis An accumulation of fibrotic tissues in the retroperitoneum (the anatomic space behind the abdominal cavity). Structures that lie behind the peritoneum are thus termed retroperitoneal. These structures include kidneys, the bladder, portions of the duodenum, portions of the colon, and the inferior vena cava. 

Prostatic hypertrophy, infection, cancer Improperly placed bladder catheter Anticholinergic medication Cancer with abdominal mass Retroperitoneal fibrosis Nephrolithiasis Nephrolithiasis Oxalate Indinavir Sulfonamides Acyclovir Uric acid... 

CYP3A4 inhibitors (eg, macrolide antibiotics, protease inhibitors) There have been rare reports of serious adverse events in connection with the coadministration. Fibrotic complications There have been reports of pleural and retroperitoneal fibrosis in patients following prolonged daily use of injectable dihydroergotamine. Risk of myocardial Ischemia and/or Ml and other adverse cardiac events Do not use dihydroergotamine in patients with documented ischemic or vasospastic coronary artery disease. 

Retroperitoneal fibrosis has been attributed to haloperidol since this condition affects the kidney, it should be differentiated from other causes of obstructive uropathy (33). 

Retroperitoneal fibrosis has been reported, not unexpectedly, in view of the structural similarity between LSD and methysergide (3). 

Timolol may also elicit dermatologic signs and symptoms that include rashes, alopecia, urticaria, and discoloration of nails. Other systemic effects reported after topical timolol treatment include myasthenia gravis and retroperitoneal fibrosis. When treating a nursing mother, clinicians should also be aware that topically applied timolol may be excreted in breast milk. 

Maguire GP, Meggs LG, Addonizio J, et al. 1991. Association of asbestos exposure, retroperitoneal fibrosis, and acute renal failure. NY State J Med 91(8) 357-359. 

Sauni R, Oksa P, Jarvenpaa R, et al. 1998. Asbestos exposure A potential cause of retroperitoneal fibrosis. Am J Ind Med 33 418-421. 

Specific cell injury or cell functional disorder occur with individual drugs or drug classes, e.g. tardive dyskinesia (dopamine receptor blockers), retinal damage (chloroquine, phenothiazines), retroperitoneal fibrosis (methysergide), NSAIDs (nephropathy). Cancer may occur, e.g. with oestrogens (endometrium) and with immunosuppressive (anticancer) drugs. 

Nausea and vomiting are the commonest adverse effects these may respond to domperidone but tend to become less marked as treatment continues. Postural hypotension may cause dizziness or syncope. In high dose confusion, delusions or hallucinations may occur and, after prolonged use, pleural effusion and retroperitoneal fibrosis. 

Tang, K.H., Schofield, J.B., Powell-Jackson, P.R. Primary biUary cirrhosis and idiopathic retroperitoneal fibrosis a rare association. Eur. J. Gastroenterol. Hepatol. 2002 14 783-786... 

Delayed portal blood flow Congenital fibrosis Liver cirrhosis Lymphoma Nodular regenerative hyperplasia Retroperitoneal fibrosis Stenoses/strictures ... 

Retroperitoneal fibrosis has been reported in patients taking oxprenolol (224), atenolol (225), propranolol (226), metoprolol (227), sotalol (228), and timolol (including eye-drops) (229,230). However, this disorder often occurs spontaneously and has been reported very infrequently in patients taking beta-blockers (231). Thus, in the absence of any causal relation it is most likely that it reflects the spontaneous incidence in patients taking a common therapy. This conclusion has been supported by an analysis of 100 cases of retroperitoneal fibrosis (232). 

Johnson JN, McFarland J. Retroperitoneal fibrosis associated with atenolol. BMJ 1980 280(6217) 864. 

Thompson J, Julian DG. Retroperitoneal fibrosis associated with metoprolol. BMJ (Clin Res Ed) 1982 284(6309) 83-4. 

Rimmer E, Richens A, Forster ME, Rees RW. Retroperitoneal fibrosis associated with timolol. Lancet 1983 1(8319) 300. 

Benitah E, Chatelain C, Cohen F, Herman D. Fibrose retroperitoneale effet systemique d un collyre beta-bloquant [Retroperitoneal fibrosis a systemic effect of beta-blocker eyedrops ] Presse Med 1987 16(8) 400-1. 

Pryor JP, Castle WM, Dukes DC, Smith JC, Watson ME, Williams JL. Do beta-adrenoceptor blocking drugs cause retroperitoneal fibrosis BMJ (Clin Res Ed) 1983 287(6393) 639 1. 

Retroperitoneal fibrosis (SEDA-12, 123) (18) and pulmonary fibrosis (SEDA-11, 130) during treatment with high doses of bromocriptine have been observed. The drug s structural relation to methysergide clearly has to be kept in mind. Pleural thickening and effusions can be present in up to 6% of patients treated with bromocriptine for Parkinson s disease, and this is related to duration of exposure and cumulative dose (19). The author recommended drug withdrawal in these patients. However, withdrawal does not always lead to complete resolution of the lesions (20). 

Hardy JC, Chevalier C, Kains JP. Fibrose retroperitoneale. A propos de troi cas dont deux induits par la bromocriptine. [Retroperitoneal fibrosis. Apropos of 3 cases 2 of which were induced by bromocriptine.] Acta Urol Belg 1991 59(3) 95-103. 

Retroperitoneal fibrosis, as produced classically by methysergide, has been reported after the administration of ergotamine (SEDA-8, 147) and dihydroergotamine (SEDA-17,170). 

In 1983, Godec and Gleich reviewed all published results of treatment of intractable hematuria with formalin. Dilutions of 1-10% formalin (containing 0.37-3.7% formaldehyde) were used the most commonly used concentration of formalin was 10%. The authors concluded that formalin was probably the most effective tool for controlling massive hematuria, but also probably the most dangerous. The review covered 23 articles and 118 patients in 104 cases, treatment was successful. However, in only 10 reports had the treatment been used without serious adverse effects the other 13 articles listed four deaths and many serious local and systemic complications. The complication rate increased when the formalin concentration was higher, but the contact time and the volume instilled did not influence the occurrence of adverse effects. The most frequent local complications were reflux and hydronephrosis. Fibrosis of the bladder with reduced capacity was the usual clinical outcome. A systemic effect was tubular necrosis with anuria, with two deaths. Another complication was ureteric obstruction, which was not related to ureteric fibrosis or bladder wall fibrosis obstructing the intramural ureter in two cases the obstruction appeared to be due to retroperitoneal fibrosis (SEDA-11, 476) (4). 

Ferrie BG, Smith PJ, Kirk D. Retroperitoneal fibrosis complicating intravesical formalin therapy. J R Soc Med 1983 76(10) 831-2. 

Jeffries JJ, Lyall WA, Bezchlibnyk K, Papoff PM, Newman F. Retroperitoneal fibrosis and haloperidol. Am J Psychiatry 1982 139(ll) 1524-5. 

Slugg PH, Kunkel RS. Comphcations of methysergide therapy retroperitoneal fibrosis, mitral regnrgitation, edema, and hemolytic anemia. JAMA 1970 213(2) 297-8. 

Renal papillary necrosis with retroperitoneal fibrosis secondary to analgesic abuse (involving aspirin, propoxyphene, and numerous other analgesics taken in large quantities for many years) has also incidentally been reported (SEDA-7, 94). 

Pergolide 3 mg/day has been associated with retroperitoneal fibrosis in an 83-year-old woman after 18 months (8). She required ureteric stents, which were removed 2 years later, after her renal function had remained stable. Because of deterioration in her Parkinson s disease the non-ergot dopamine receptor agonist ropinirole was started and treatment was uneventful after 12 months. 

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