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Diagnosis and follow-up of idiopathic retroperitoneal fibrosis: role of 18F-FDG-PET/CT and biochemical parameters in patients with renal involvement

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Abstract

Idiopathic retroperitoneal fibrosis (IRF) is a rare disease characterized by fibro-inflammatory reaction surrounding ureters and other inner organs with possible secondary renal involvement. Symptoms are aspecific and recurrent phases of activity are generally associated with elevation of inflammatory indices. 18F-FDG-PET is nowadays an important tool for the detection of this disease, allowing differentiation between metabolically active tissue and fibrotic one. The purpose of this study was to investigate the role of 18F-FDG-PET in the management of IRF and to evaluate possible correlations between biochemical parameters and PET/CT findings of disease activity. We enrolled seven consecutive patients with IRF (in five histology proved the disease) observed from 2003 to 2012 (5 M:2 F, mean age 53.8 years, range 44–86 years). All patients presented with fever as first symptom; two had obstructive renal failure requiring hemodialysis; one underwent monolateral nephrectomy for parenchyma infiltration; six presented ureteral involvement; three underwent ureteral stent placement. For each patient, during a mean total follow-up of 26.5 months we evaluated serum creatinine, BUN, Hb, RBCs, WBCs, PLT, CRP, ESR. Periodic 18F-FDG-PET/CT scans (every 5.9 months—mean) were performed in all patients. Statistical evaluation was performed using “stepwise regression” analysis. Steroids and immunosuppressive agents induced a progressive normalization of PET/CT scans in all patients at the end of follow-up. Stepwise regression analysis showed that BUN, serum creatinine and CRP only if considered together, significantly correlated with SUV max (p value = 0.000003057). 18F-FDG-PET is a useful tool for clinical decision making in patient with IRF, allowing to evaluate the efficacy of the pharmacological treatment and to detect early recurrences, to modify the therapeutic approach. Acute phase reactants are not reliable alone for the management and the follow-up as they are often not concordant with metabolic assessment of the disease. In patients with ureteral involvement, CRP together with BUN and serum creatinine has a significant correlation with PET/CT results, and can help physicians in therapeutic approach, better than a single parameter.

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Acknowledgments

The authors thank for the statistical analysis Prof. Maurizio Maravalle, Department of Information Engineering, Computer Science and Mathematics, University of L'Aquila, 67100 Coppito (AQ), Italy.

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Authors and Affiliations

  1. Nephrology and Dialysis Unit, Sant’Andrea Hospital, Second School of Medicine, Sapienza University of Rome, Rome, Italy

    Claudia Fofi, Laura Pettorini, Francescaromana Festuccia, Giorgio Punzo & Paolo Menè

  2. Department of Nuclear Medicine, Sant’Andrea Hospital, Second School of Medicine, Sapienza University of Rome, Rome, Italy

    Daniela Prosperi, Riccardo Pirisino & Francesco Scopinaro

  3. Institute of Nuclear Medicine, Catholic University of the Sacred Heart, Rome, Italy

    Valerio Lanni

Authors
  1. Claudia Fofi
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  2. Daniela Prosperi
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  3. Laura Pettorini
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  4. Francescaromana Festuccia
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  9. Paolo Menè
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Correspondence to Claudia Fofi.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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For this type of retrospective study formal consent is not required.

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Fofi, C., Prosperi, D., Pettorini, L. et al. Diagnosis and follow-up of idiopathic retroperitoneal fibrosis: role of 18F-FDG-PET/CT and biochemical parameters in patients with renal involvement. Intern Emerg Med 11, 809–816 (2016). https://doi.org/10.1007/s11739-016-1426-6

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  • DOI: https://doi.org/10.1007/s11739-016-1426-6

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