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Methotrexate plus prednisone in patients with relapsing idiopathic retroperitoneal fibrosis
  1. Federico Alberici1,
  2. Alessandra Palmisano1,
  3. Maria L Urban1,
  4. Federica Maritati1,
  5. Elena Oliva1,
  6. Lucio Manenti1,
  7. Stefania Ferretti2,
  8. Rocco Cobelli3,
  9. Carlo Buzio1,
  10. Augusto Vaglio1
  1. 1 Nephrology Unit, Parma University Hospital, Parma, Italy
  2. 2 Urology Unit, Parma University Hospital, Parma, Italy
  3. 3 Radiology Service, Parma University Hospital, Parma, Italy
  1. Correspondence to Dr Augusto Vaglio, Unità Operativa di Nefrologia, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, Parma 43126, Italy; augusto.vaglio{at}

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Idiopathic retroperitoneal fibrosis (IRF) is a rare disease, characterised by a fibroinflammatory tissue surrounding the aortoiliac axis and frequently entrapping the ureters.1 ,2 Glucocorticoids effectively induce remission, but 24% to 72% of patients relapse, half of them repeatedly.3 ,4 Immunosuppressants and glucocorticoids are usually required in relapsing IRF but no studies are available.

In this prospective, open-label trial we enrolled 16 relapsing patients with IRF (July 2004 to April 2011) aged 18–85 years and with an estimated glomerular filtration rate (eGFR)>50 ml/min5 after ureteral decompression (if required), and treated them with methotrexate and prednisone for 12 months. Relapse was defined in case of mass enlargement, hydronephrosis, or disease-related symptoms associated with high inflammatory markers.3 Prednisone was given at 0.5–1 mg/kg/day depending on flare severity, tapered to 12.5–10 mg/day by month 3, 7.5–5 mg/day by month 6 and maintained at 5–2.5 mg/day until month 12. Methotrexate was given at 15–20 mg/week until month 12. After month 12, the clinician was free to continue or withdraw the treatment.

The primary endpoint was remission (at month 12) defined as a stable, reduced mass and absence of hydronephrosis, disease-related symptoms and normal inflammatory markers.3 Secondary endpoints were changes in erythrocyte sedimentation …

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  • Contributors AV, FA and CB designed the work, followed the patients, analysed the data and wrote the manuscript. AP, MLU, LM, EO and LM followed the patients, collected the data and contributed to generating the figures. SF was in charge of the urological follow-up of the patients. RC analysed imaging studies.

  • Funding This work was supported by the University Hospital of Parma (non-monetary support). The supporter did not have any role in study design.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethical Committee of Parma.

  • Provenance and peer review Not commissioned; externally peer reviewed.