Uspešno lečenje idiopatske retroperitonealne fibroze kombinovanom imunosupresivnom terapijom

  • Katarina Obrenčević Military Medical Academy, Solid Organ Transplantation Center, Belgrade, Serbia
  • Dejan Petrović University of Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Kragujevac, Serbia
  • Predrag Aleksić Military Medical Academy, Clinic for Urology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Marijana Petrović Military Medical Academy, Clinic for Nephrology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Nemanja Rančić Military Medical Academy, Centre for Clinical Pharmacology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Dragan Jovanović Military Medical Academy, Clinic for Nephrology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Bojan Nikolić Military Medical Academy, Institute of Radiology, Belgrade, Serbia
  • Mirjana Mijušković Military Medical Academy, Clinic for Nephrology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
  • Neven Vavić Military Medical Academy, Solid Organ Transplantation Center, Belgrade, Serbia
  • Ljiljana Ignjatović Military Medical Academy, Clinic for Nephrology, Belgrade, Serbia
  • Djoko Maksić Military Medical Academy, Clinic for Nephrology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP170714008O
Ključne reči: retroperitonealna fibroza, bubreg, insuficijencija, autoimunske bolesti, kortikosteroidni hormoni, mikofenolna kiselina, remisija, indukcija, recidiv

Sažetak


Apstrakt

 

Uvod/Cilj. Idiopatska retroperitonealna fibroza (IRF) karakteriše se periaortnim fibroinflamatornim tkivom koje zahvata uretere dovodeći do opstruktivne nefropatije i različitog stepena bubrežne insuficijencije. Oboljenje je najverovatnije autoimune etiologije. Optimalna terapija do sada nije definisana. Cilj rada bio je analiza dugoročne efikasnosti kombinovane imunosupresivne terapije kortikosteroidima i mikofenolat mofetilom u lečenju IRF. Metode. Retrospektivno je praćeno 13 bolesnika (8 muškaraca i 5 žena) sa IRF. Svi bolesnici su primili kortikosteroide i mikofenolat mofetil (MMF). Kod bolesnika sa izraženom bubrežnom insuficijencijom, prvo je učinjena dekompresija urinarnog trakta i potom započeta terapija peroralnim prednizonom 0,5 mg/kg sa brzim smanjivanjem doze. Bolesnici sa umerenom bubrežnom slabošću primili su inicijalno tri pulsne doze metilprednizolona intravenski, a potom je nastavljeno sa prednizonom. Doza MMF je bila 1000 mg dva puta dnevno. MMF je obustavljen nakon 18 meseci, a prednizon nakon 48 meseci. Rezultati. Kod svih bolesnika došlo je do povlačenja opštih simptoma bolesti. Vrednost sedimentacije eritrocita (SE) smanjena je sa prosečnih 67,6 na 26,3 mm/h, a C-reaktivnog proteina (CRP) sa prosečih 18,5 na 6,3 mg/L. Kod sedam od ukupno osam bolesnika, ureteralni stentovi su uspešno izvađeni nakon prosečno 13 nedelja. Sedam bolesnika imalo je 100% redukciju periaortnog tkiva, a prosečni stepen redukcije je bio 76,9%. Bubrežna funkcija je poboljšana, kod šest bolesnika je normalizovana, dok je kod četiri zaostala umerena hronična bubrežna slabost usled afunkcije jednog bubrega. Tri bolesnika sa prethodnom hroničnom bubrežnom insuficijencijom nisu pogoršala funkciju. Recidiv bolesti imala su tri bolesnika. Nisu registrovani neželjeni efekti terapije. Zaključak. Kombinovana primena kortikosteroida i MMF je potencijalno efikasna terapija u poboljšanju bubrežne funkcije i smanjenju debljine fibroznog tkiva kod bolesnika sa IRF. Ona bi mogla otkloniti potrebu za plasiranjem ureteralnih stentova i hirurškim lečenjem. Duže trajanje terapije moglo bi smanjiti mo­guć­nost recidiva bolesti.

Reference

REFERENCES

Vaglio A, Salvarani C, Buzio C. Retroperitoneal fibrosis. Lancet 2006; 367(9506): 241–51.

van Bommel EF, Jansen I, Hendriksz TR, Aarnoudse AL. Idiopathic Retroperitoneal Fibrosis: prospective evaluation of incidence and clinicoradiologic presentation. Medicine (Baltimore) 2009; 88(4): 193–201.

Miller OF, Smith LJ, Ferrara EX, McAleer IM, Kaplan GW. Presentation of idiopathic retroperitoneal fibrosis in the pediatric population. J Pediatr Surg 2003; 38(11): 1685–8.

Parum DV, Brown DL, Mitchinson MJ. Serum antibodies to oxi-dized low-density lipoprotein and ceroid in the chronic pe-riaortitis. Arch Pathol Lab Med 1990; 114(4): 383–7.

Vaglio A, Corradi D, Manenti L, Ferretti S, Garini G, Buzio C. Evidence of autoimmunity in chronic periaortitis: a prospec-tive study. Am J Med 2003; 114(6): 454–62.

Fujimori N, Ito T, Igarashi H, Oono T, Nakamura T, Niina Y, et al. Retroperitoneal fibrosis associated with immunoglobulin G4-related disease. World J Gastroenterol 2013; 19(1): 35.

Rossi GM, Rocco R, Accorsi Buttini E, Marvisi C, Vaglio A. Idi-opathic retroperitoneal fibrosis and its overlap with IgG4-related disease. Intern Emerg Med 2017; 12(3): 287–99.

Jogai S, Al-Jassar A, Temmim L. Idiopathic retroperitoneal fibrosis - a potential pitfall for fine needle aspiration cytology. Cytopathology 2005; 16(1): 49–50.

Warnatz K, Keskin AG, Uhl M, Scholz C, Katzenwadel A, Vaith P, et al. Immunosuppressive treatment of chronic periaortitis: a retrospective study of 20 patients with chronic periaortitis and a review of the literature. Ann Rheum Dis 2005; 64(6): 828–33.

Adler S, Lodermeyer S, Gaa J, Heemann U. Successful mycophe-nolate mofetil therapy in nine patients with idiopathic retroperitoneal fibrosis. Rheumatology (Oxford) 2008; 47(10): 1535–8.

Scheel PJ Jr, Sozio SM, Feeley N. Medical management of retro-peritoneal fibrosis. Trans Am Clin Climatol Assoc 2012; 123: 283–90; discussion 290–1.

Binder M, Uhl M, Wiech T, Kollert F, Thiel J, Sass JO, et al. Cyclophosphamide is a highly effective and safe induction therapy in chronic periaortitis: a long-term follow-up of 35 patients with chronic periaortitis. Ann Rheum Dis 2011; 71(2): 311–2.

Yan Y, Zhou B, Lan T, Wang X, Li C, Zhou H. Retroperitoneal Fibrosis: A Retrospective Clinical Data Analysis of 30 Patients in a 10-year Period. Chin Med J (Engl) 2015; 128(6): 804–10.

Scheel PJ, Feeley N. Retroperitoneal Fibrosis: the clinical, laboratory and radiographic presentation. Medicine 2009; 88(4): 202–7.

Kermani TA, Crowson CS, Achenbach SJ, Luthra HS. Idiopathic Retroperitoneal Fibrosis: A Retrospective Review of Clinical Presentation, Treatment, and Outcomes. Mayo Clin Proceed 2011; 86(4): 297–303.

Bullimore DW. Retroperitoneal fibrosis associated with atenolol. Br Med J 1980; 281(6232): 59–60.

Thompson J, Julian DG. Retroperitoneal fibrosis associated with metoprolol. Br Med J 1982; 284(6309): 83–4.

Pryor JP, Castle WM, Dukes DC, Smith JC, Watson ME, Williams JL. Do beta-adrenoceptor blocking drugs cause retroperitoneal fibrosis? Br Med J (Clin Res Ed) 1983; 287(6393): 639–41.

van Bommel EF. Retroperitoneal fibrosis. Neth J Med 2002; 60(6): 231–42.

Urban ML, Palmisano A, Nicastro M, Corradi D, Buzio C, Vaglio A. Idiopathic and secondary forms of retroperitoneal fibrosis: A diagnostic approach. Rev Méd Interne 2015; 36(1): 15–21.

Ceresini G, Urban ML, Corradi D, Lauretani F, Marina M, Usberti E, et al. Association between idiopathic retroperitoneal fibrosis and autoimmune thyroiditis: A case–control study. Autoimmun Rev 2015; 14(1): 16–22.

Vaglio A, Manenti L, Allegri L, Ferrozzi F, Corradi D, Buzio C. ANCA-positive periaortic vasculitis: does it fall within the spectrum of vasculitis?. Intern Med 2002; 251(3): 268–71.

Moroni G, Faricciotti A, Cappelletti M, Ponticelli C. Retroperitoneal fibrosis and membranous nephropathy. Improvement of both diseases after treatment with steroids and immunosuppressive agents. Nephrol Dial Transplant 1999; 14(5): 1303–5.

Vaglio A, Palmisano A, Ferretti S, Alberici F, Casazza I, Salvarani C, et al. Peripheral inflammatory arthritis in patients with chronic periaortitis: report of five cases and review of the literature. Rheumatology 2007; 47(3): 315–8.

Demko TM, Diamond JR, Groff J. Obstructive nephropathy as a result of retroperitoneal fibrosis: a review of its pathogenesis and associations. J Am Soc Nephrol 1997; 8(4): 684–8.

Famularo G, Palmisano A, Afeltra A, Buzzulini F, Versari A, Minisola G, et al. Retroperitoneal fibrosis associated with psoriasis: a case series. Scand J Rheum 2009; 38(1): 68–9.

Moroni G, Gallelli B, Banfi G, Sandri S, Messa P, Ponticelli C. Long-term outcome of idiopathic retroperitoneal fibrosis treated with surgical and/or medical approaches. Nephrol Dial Transplant 2006; 21(9): 2485–90.

Vaglio A, Maritati F. Idiopathic Retroperitoneal Fibrosis. J Am Soc Nephrol 2016; 27(7): 1880–9.

Kardar AH, Kattan S, Lindstedt E, Hanash K. Steroid Therapy For Idiopathic Retroperitoneal Fibrosis: Dose And Duration. J Urol 2002; 168(2): 550–5.

Baker LR, Mallinson WJ, Gregory MC, Menzies EA, Cattell WR, Whitfield HN, et al. Idiopathic Retroperitoneal Fibrosis. A Re-trospective Analysis of 60 Cases. Br J Urol 1987; 60(6): 497–503.

Scheel PJ Jr, Feeley N. Retroperitoneal Fibrosis. Rheum Dis Clin North Am 2013; 39(2): 365–81.

Vaglio A, Palmisano A, Alberici F, Maggiore U, Ferretti S, Cobelli R, et al. Prednisone versus tamoxifen in patients with idiopathic retroperitoneal fibrosis: an open-label randomised controlled trial. Lancet 2011; 378(9788): 338–46.

Scheel PJ Jr, Feeley N, Sozio SM. Combined Prednisone and My-cophenolate Mofetil Treatment for Retroperitoneal Fibrosis: a case series. Ann Intern Med 2011; 154(1): 31–6.

Labidi J, Chargui S, Louzir B, Othmani S, Ariba Y, Bousetta N. Retroperitoneal fibrosis: A retrospective review of clinical presentation, treatment and outcomes. Saudi J Kidney Dis Transpl 2015; 26(4): 816–22.

van Bommel EF, Pelkmans LG, van Damme H, Hendriksz TR. Long-term safety and efficacy of a tamoxifen-based treatment strategy for idiopathic retroperitoneal fibrosis. Eur J Intern Med 2013; 24(5): 444–50.

Marcolongo R, Tavolini IM, Laveder F, Busa M, Noventa F, Bassi P, et al. Immunosuppressive therapy for idiopathic retroperitoneal fibrosis: a retrospective analysis of 26 cases. Am J Med 2004; 116(3): 194–7.

van Bommel EF, Siemes C, Hak LE, van der Veer SJ, Hendriksz TR. Long-Term Renal and Patient Outcome in Idiopathic Re-troperitoneal Fibrosis Treated With Prednisone. Am J Kidney Dis 2007; 49(5): 615–25.

Harreby M, Bilde T, Helin P, Meyhoff HH, Vinterberg H, Nielsen VA. Retroperitoneal fibrosis treated with methylprednisolon pulse and disease-modifying antirheumatic drugs. Scand J Urol Nephrol 1994; 28(3): 237–42.

Gonçalves RG, Biato MA, Colosimo RD, Martinusso CA, Pecly ID, Farias EK, et al. Effects of Mycophenolate Mofetil and Lisinopril on Collagen Deposition in Unilateral Ureteral Obstruction in Rats. Am J Nephrol 2004; 24(5): 527–36.

Morath C, Schwenger V, Beimler J, Mehrabi A, Schmidt J, Zeier M, et al. Antifibrotic actions of mycophenolic acid. Clin Transpl 2006; 20(Suppl 17): 25–9.

Grotz W, von Zedtwitz I, Andre M, Schollmeyer P. Treatment of retroperitoneal fibrosis by mycophenolate mofetil and corticosteroids. Lancet 1998; 352(9135): 1195.

Jois RN, Kerrigan N, Scott DG. Mycophenolate mofetil for maintenance of remission in idiopathic retroperitoneal fibrosis. Rheumatology 2006; 46(4): 717–8.

Khalil F, Mir MA, Venuto RC. Mycophenolate mofetil in the treatment of retroperitoneal fibrosis. Clin Rheumatol 2008; 27(5): 679–81.

Swartz RD, Lake AM, Roberts WW, Faerber GJ, Wolf JS Jr. Idi-opathic retroperitoneal fibrosis: a role for mycophenolate mo-fetil. Clin Nephrol 2008; 69(4): 260–8.

Moody TE, Vaughan ED Jr. Steroids in the Treatment of Retroperitoneal Fibrosis. J Urol 1979; 121(1): 109–11.

Moroni G, Dore R, Colini P. Idiopathic retroperitoneal fibrosis. J Nephrol 2005; 18(6): 794–808.

Pelkmans LG, Aarnoudse AL, Hendriksz TR, van Bommel EF. Value of acute-phase reactants in monitoring disease activity and treatment response in idiopathic retroperitoneal fibrosis. Nephrol Dial Transpl 2012; 27(7): 2819–25.

Vaglio A, Greco P, Versari A, Filice A, Cobelli R, Manenti L, et al. Post-treatment residual tissue in idiopathic retroperitoneal fibrosis: active residual disease or silent "scar"?, A study using 18F-fluorodeoxyglucose positron emission tomography. Clin Exp Rheumatol 2005; 23(2): 231–4.

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2021/05/11
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Vol. 76 Br. 10 (2019): Vojnosanit Pregl
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