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Answer 4
  1. Bilateral percutaneous nephrostomy tube placement. This patient needs acute management of her renal failure and hyperkalemia. The goal in the management of RPF depends on the severity of the disease at diagnosis, with the primary goal of preserving renal function. Patients presenting with uremia should be urgently decompressed with indwelling ureteral stents or percutaneous nephrostomy tubes to protect renal function.4 If the patient is critically ill with anuria and hyperkalemia, nephrostomy tubes can be placed under ultrasound guidance with local anesthesia. High-dose steroid therapy, CT-guided biopsy of the retroperitoneal mass, and surgical ureterolysis are therapeutic options for presumed RPF but are not performed in the acute setting. Spontaneous resolution is rare unless a known inciting drug is discontinued in a patient with a mild form of RPF.

    4. Varkarakis IM, Jarrett TW. Retroperitoneal fibrosis. AUA Update Series 2005;24:18-23.

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