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    "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor&#58; </span></p><p class="elsevierStylePara">Retroperitoneal fibrosis represents a diagnostic challenge due to the low frequency of presentation and the lack of specific symptoms&#46; It is characterised by the presence of fibro-inflammatory tissue that surrounds the abdominal aorta and the iliac arteries<span class="elsevierStyleSup">1</span> extending to the retroperitoneal space and it covers neighbouring structures&#44; such as ureters&#44; causing obstructive uropathy &#40;OU&#41;&#46;</p><p class="elsevierStylePara">Although cases associated with multiple conditions &#40;drugs&#44; neoplasias&#44; radiation and infection&#44; amongst others&#41; have been described&#44; the most common cause is idiopathic&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">Idiopathic retroperitoneal fibrosis is more common in men aged 50-60 years old and&#44; in most patients&#44; it presents as non-specific lower back or abdominal pain&#46;<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">When the retroperitoneal tissue covers one or both ureters&#44; potentially reversible obstructive renal failure occurs&#46;<span class="elsevierStyleSup">1&#44;2&#44;4</span></p><p class="elsevierStylePara">We report the case of a patient with idiopathic retroperitoneal fibrosis that progressed to marked OU and an ultrasound showed slight unilateral dilation of the excretory system&#46;</p><p class="elsevierStylePara">Our patient was a 54-year-old male&#44; with no relevant personal or family history&#44; referred by the General Practitioner due to incidental findings in the blood test of creatinine 2&#46;74mg&#47;dl&#46; The patient had a history of three weeks of nausea&#44; non-specific abdominal pain and slight testicular pain&#44; with no other accompanying symptoms&#46; Upon physical examination&#44; he was normotensive and afebrile&#44; with diuresis maintained&#44; without macroscopic abnormalities&#44; at around 2000ml&#47;day&#46;</p><p class="elsevierStylePara">In the blood test obtained from the Emergency department&#44; the following parameters are notable&#58; haemoglobin 15&#46;3g&#47;dl&#44; leukocytes 6700&#47;&#181;l&#44; platelets 305&#44;000&#47;&#181;l&#44; sodium 133mEq&#47;l&#44; potassium 3&#46;6mEq&#47;l&#44; hepatic-pancreatic profile with no abnormalities&#44; lactate hydrogenase 270U&#47;l&#44; plasma creatinine 3mg&#47;dl&#44; urea 116mg&#47;dl&#46; Urine biochemistry displayed values for sodium of 96mEq&#47;l and potassium of 28mEq&#47;l&#46;</p><p class="elsevierStylePara">The renal ultrasound &#40;Figure 1&#41;&#44; showed normal-sized kidneys with cortical thickness maintained and we noted that the right side was larger and thicker&#46; It showed slight dilatation of the right renal calyces &#40;Figure 1&#41; and no cause of dilation was seen with a bilateral positive ureteral jet on colour Doppler ultrasound&#46;</p><p class="elsevierStylePara">Given the poor test performance with progressive deterioration of renal function&#44; a computerised tomography &#40;CT&#41; scan of the abdomen was carried out &#40;Figure 2&#41;&#46; It revealed a large retroperitoneal mass that covered the right ureter&#44; with the left ureter free&#44; but on the limit of the edge of the latter&#44; resulting in bilateral OU&#44; although it was more pronounced on the right side&#46; The left side only showed incipient signs of obstruction&#46;</p><p class="elsevierStylePara">After the diagnosis&#44; he was treated empirically with high doses of prednisone and it was decided to use bilateral double-J catheters&#59; following this treatment immediate improvement was noted&#46; Five days later&#44; the patient was asymptomatic and 30 days after starting steroid treatment&#44; plasma creatinine was 1&#46;02mg&#47;dl&#46; The double-J catheters were removed 6 months after the start of treatment&#44; with stable plasma creatinine figures being maintained&#46;</p><p class="elsevierStylePara">This case is of interest because&#44; in spite of being an obstructive disease&#44; ultrasound does not make clear the cause of obstruction&#44; and on many occasions it fails to reveal the existence of the urinary tract obstruction itself&#46; This is due to ureteral rigidity that conditions the disease itself&#44; preventing dilation of the ureter covered by fibro-inflammatory mass&#46;</p><p class="elsevierStylePara">In the case that we have presented&#44; the patient displayed a significant impairment in renal function secondary to bilateral OU &#40;right established and left incipient&#41;&#44; with CT being required for its diagnosis&#46;</p><p class="elsevierStylePara">Therefore&#44; it is necessary to evaluate the need for other imaging techniques such as CT or MRI&#44;<span class="elsevierStyleSup">5</span> in order to diagnose this entity&#44; since treatment started at an early stage improves the clinical profile&#46;</p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article&#46;</p><p class="elsevierStylePara"><a href="grande&#47;11705&#95;16025&#95;46815&#95;en&#95;11705&#95;f1&#46;jpg" class="elsevierStyleCrossRefs"><img src="11705_16025_46815_en_11705_f1.jpg" alt="Right kidney ultrasound"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Right kidney ultrasound</p><p class="elsevierStylePara"><a href="grande&#47;11705&#95;16025&#95;46816&#95;en&#95;11705&#95;f2&#46;jpg" class="elsevierStyleCrossRefs"><img src="11705_16025_46816_en_11705_f2.jpg" alt="Computerised tomography"></img></a></p><p class="elsevierStylePara">Figure 2&#46; Computerised tomography</p>"
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