Asbestos exposure: a potential cause of retroperitoneal fibrosis

Our plain-English summary of Asbestos exposure: a potential cause of retroperitoneal fibrosis, by R. Sauni, P. Oksa, R. Järvenpää, et al (American Journal of Industrial Medicine, 1998).

The study

• Authors: R. Sauni, P. Oksa, R. Järvenpää, J.E. Parker, P. Roto
• Journal: American Journal of Industrial Medicine
• Published: 1998;33(4):418-21
• Cited by: 14 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The etiology of retroperitoneal fibrosis is unknown in 70% of the cases. The aim of our study was to examine the possible association between occupational asbestos exposure and retroperitoneal fibrosis; only two cases have been reported in the literature. We gathered all the cases of retroperitoneal fibrosis diagnosed in the Tampere University Hospital between 1987 and 1995. We examined their hospital records to evaluate the possible etiology of the disease. We also sent a structured questionnaire to all living patients (10/13) to obtain information on their asbestos exposure. The chest radiographs of the patients were re-read to evaluate possible changes resulting from asbestos exposure. We found 13 cases of idiopathic retroperitoneal fibrosis. Seven patients (all male) had been exposed to asbestos in the past. The chest radiographs of the four most-exposed patients showed characteristic asbestos-related abnormalities, including bilateral pleural plaques, round atelectasis and small irregular lung opacities. In our study, we found that asbestos exposure and asbestos-induced changes in the lung and pleura were common among male retroperitoneal fibrosis patients. We suggest that occupational exposure to asbestos may be an important etiological factor for retroperitoneal fibrosis.

In plain English

This study looked back at 13 patients with idiopathic retroperitoneal fibrosis, a fibrous mass over the abdominal blood vessels that can block the ureters, diagnosed at Tampere University Hospital from 1987 to 1995. They were found among 45 patients coded with ureteric obstruction, and diagnosis required confirmation at surgery; patients whose disease presented without ureteral obstruction were not included. There were 7 men and 6 women, mean age 57 at diagnosis. The authors reviewed hospital records, chest X-rays and CT images, and sent an asbestos questionnaire to the 10 living patients. All seven men had occupational asbestos exposure, in jobs such as insulator, plumber, painter and mechanic; the authors compared this with about 5% of Finland's labor force. Four of these men had X-ray changes typical of asbestos, such as bilateral pleural plaques; one more had a one-sided plaque. Three women reported no exposure; for three, exposure was not known. Three women and one man had other possible causes, such as aortic aneurysm. The authors suggested asbestos may be an important cause and called for a case-control study to confirm it.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective case series of hospital cases, using record review, re-reading of chest radiographs and CT images, and an exposure questionnaire
• Who was studied: 13 patients with idiopathic retroperitoneal fibrosis (7 men, 6 women; mean age 57 at diagnosis) at Tampere University Hospital, southern Finland, diagnosed 1987 to 1995. They were identified among 45 patients with diagnosis code 5934A ('other ureteric obstruction'), and the diagnosis had to be confirmed by laparotomy. Patients presenting other than with ureteral obstruction were not included. 10 were alive at the time of the study.
• Exposure: Occupational asbestos exposure assessed by structured questionnaire and, if needed, telephone interview. Jobs included insulator, plumber/carpenter, carpenter, painter, automobile engineer (brake repair) and automobile mechanic. No fiber types or doses were given.
• Main results:
  • All seven male patients had asbestos exposure in their occupational history. The authors compared this with about 5% of the total Finnish labor force, a figure taken from another source.
  • Chest radiographs showed changes typical of asbestos in four of the seven exposed male patients (patients 1, 3, 4, 7).
  • One further male patient (patient 6) had a unilateral pleural plaque, which the authors called suggestive.
  • The rate of bilateral plaques among the male patients was eight times that of the Finnish male population, as reported in another study.
  • In Table I, the remaining patients were the women. Three (patients 11 to 13) were listed with no asbestos exposure. For three (patients 8 to 10), exposure was listed as not known, with a footnote that appears to say these patients had died.
  • Patient 1, an insulator, was diagnosed with asbestosis in 1994 on the basis of computerized tomography.
  • Three of the six female patients and one male patient had risk factors for retroperitoneal fibrosis other than asbestos, such as aortic aneurysm (patients 2 and 11).
• The authors' conclusion: The authors suggested that occupational asbestos exposure may be an important cause of retroperitoneal fibrosis. They encouraged a formal epidemiological case-control study to confirm the association.
• Limitations the authors state:
  • Patients whose retroperitoneal fibrosis presented in ways other than ureteral obstruction were not included.
  • Chest radiographs do not detect all asbestos-related disease, and changes may appear later.
  • Patients may have had other causes the authors were unable to recognize.
  • The authors called for a case-control study to confirm the association.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Fibrosis, Etiology, Chest X-Ray, Idiopathic, Bilateral, Pleural Plaques, Atelectasis.

Related studies

• Asbestos exposure as a risk factor for retroperitoneal fibrosis — T. Uibu, P. Oksa, et al. (2004)
• Idiopathic retroperitoneal fibrosis: prospective evaluation of incidence and clinicoradiologic presentation — E.F.H. van Bommel, I. Jansen, et al. (2009)
• Asbestos-related pleural and lung fibrosis in patients with retroperitoneal fibrosis — T. Uibu, R. Järvenpää, et al. (2008)
• Asbestos and smoking as risk factors for idiopathic retroperitoneal fibrosis: a case-control study — M. Goldoni, S. Bonini, et al. (2014)
• Syndrome of pleural and retrosternal "bridging" fibrosis and retroperitoneal fibrosis in patients with asbestos exposure — V. Cottin, P.Y. Brillet, et al. (2008)
• Idiopathic retroperitoneal fibrosis: an update for nephrologists — V. Raglianti, G.M. Rossi, et al. (2021)

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