Idiopathic retroperitoneal fibrosis; Ormond's disease
Retroperitoneal fibrosis is a rare disorder that blocks the tubes (ureters) that carry urine from the kidneys to the bladder.
Retroperitoneal fibrosis occurs when extra fibrous tissue forms in the area behind the stomach and intestines. The tissue forms a mass (or masses) or tough fibrotic tissue. It can block the tubes that carry urine from the kidney to the bladder.
The cause of this problem is mostly unknown. It is most common in people aged 40 to 60. Men are twice as likely to develop the condition as women.
- Dull pain in the abdomen or flank that increases with time
- Pain and change of color in the legs (due to decreased blood flow)
- Swelling of one leg
- Decreased urine output
- No urine output (anuria)
- Nausea, vomiting, changes in mental status caused by kidney failure and build-up of toxic chemicals in the blood
- Severe abdominal pain with blood in the stool (due to death of intestinal tissue)
Exams and Tests
Abdominal CT scan is the best way to find a retroperitoneal mass.
Other tests that can help diagnose this condition include:
- BUN and creatinine blood tests
- Intravenous pyelogram (IVP), not as commonly used
- Kidney ultrasound
- MRI of the abdomen
- CT scan of the abdomen and retroperitoneum
A biopsy of the mass may also be done to check for cancer.
Corticosteroids are tried first. Some health care providers also prescribe a drug called tamoxifen.
If corticosteroid treatment does not work, a biopsy should be done to confirm the diagnosis. Other medicines to suppress the immune system can be prescribed.
When medicine does not work, surgery and stents (draining tubes) are needed.
The outlook will depend on the extent of the problem and the amount of damage to the kidneys.
The kidney damage may be temporary or permanent.
The disorder may lead to:
- Ongoing blockage of the tubes leading from the kidney on one or both sides
- Chronic kidney disease or failure
When to Contact a Medical Professional
Contact your provider if you have lower abdomen or flank pain and less output of urine.
Try to avoid long-term use of medicines that contain methysergide. This drug has been shown to cause retroperitoneal fibrosis. Methysergide is sometimes used to treat migraine headaches.
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Last reviewed on: 4/1/2023
Reviewed by: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.