In the past, most physicians reserved steroid therapy for patients unfit for surgery or with extensive involvement of the main vessels. However, studies that have demonstrated success with steroid administration combined with modern imaging techniques (to obtain percutaneous biopsies to rule out malignancy) have led to the use of glucocorticoids alone or in combination with other immunosuppressive agents as an alternative primary treatment.5 Most treatment successes of RPF as described by case reports in the literature have used steroid monotherapy. Additional studies have shown that tamoxifen, a nonsteroidal antiestrogen, and immunosuppressive agents such as azathioprine, cyclophosphamide, mycophenolate mofetil, and penicillamine, are effective medical therapies for RPF. Immunosuppressive agents are usually used in combination with a reduced dose of steroids.
5. Kardar AH, Kattan S, Lindstedt E, Hanash K. Steroid therapy for idiopathic retroperitoneal fibrosis: dose and duration. J Urol 2002;168:550-5.
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