Retroperitoneal fibrosis and asbestosis--a plausible association?

Our plain-English summary of Retroperitoneal fibrosis and asbestosis--a plausible association?, by R.D. Swartz (American Journal of Kidney Diseases, 2015).

The study

• Author: R.D. Swartz
• Journal: American Journal of Kidney Diseases
• Published: 2015;65(3):378-80
• Type of article: Editorial, Comment
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This article was a commentary, not a new study. The author discussed a 2014 case-control study by Goldini and colleagues in the Annals of Internal Medicine. That study compared 90 patients with idiopathic retroperitoneal fibrosis (RPF), an inflammation around the lower aorta that can block the ureters, with 270 matched controls in Italy. Asbestos exposure was assessed from clinical histories and a questionnaire. It reported that 38% of RPF patients had no asbestos exposure versus 69% of controls, and 16% had no smoking history versus 35% of controls. The author pointed out that the Italian study relied only on histories and questionnaires and did not report any pleuropulmonary asbestosis or asbestos material identified in biopsies. The author also noted three things. Earlier RPF case series reported few, if any, patients with identified asbestos exposure, though exposure may have been underrecognized. Most series found no asbestos fibrils in biopsies. And RPF tends to respond well to corticosteroids and immunomodulation, which the author described as ineffective for asbestosis. The author concluded that a causal link between asbestos and RPF remains speculative.

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: Commentary on another published study (a case-control study by Goldini et al, 2014); the article reports no original data
• Who was studied: No patients were studied in this article. The study it discusses compared 90 patients with idiopathic retroperitoneal fibrosis with 270 matched controls in Italy.
• Exposure: In the study discussed, asbestos exposure (direct or indirect) and smoking were assessed from clinical histories and a previously published questionnaire. No fiber types are named.
• Main results:
  • As reported in the commentary, in the Goldini et al study 38% of RPF patients had no asbestos exposure, compared with 69% of controls.
  • As reported in the commentary, in the Goldini et al study 16% of RPF patients had no smoking history, compared with 35% of controls.
  • The commentary described the Goldini et al study as finding a strong statistical relation among reported asbestos exposure, smoking and a diagnosis of idiopathic RPF.
  • The author noted that the Goldini et al report did not report any pleuropulmonary asbestosis occurring alongside RPF. It also did not report any identification of asbestos material in biopsies of the RPF patients. The commentary does not say whether these were looked for and found absent.
  • The author cited a Finnish study by Uibi et al that compared chest tomography in asbestos-exposed RPF patients and asbestos-exposed controls. It described some asbestosis in both groups, but more prominent pleural plaques and diffuse pleural thickening in the RPF patients.
  • The author stated that previous RPF case series include few if any patients with identified asbestos exposure. The author also acknowledged that those reports may have overlooked exposure.
  • The author stated that most RPF case series fail to find asbestos fibrils in biopsy specimens.
  • The author noted that RPF tends to respond well to corticosteroids and immunomodulation, which the author described as ineffective in treating asbestosis.
  • The author stated that the specific role of smoking in RPF inflammation remains suggestive but unproved.
• The authors' conclusion: The author concluded that inflammatory mechanisms set off by asbestosis may possibly play a role in RPF, but that a causal relation remains speculative for now.
• Limitations the authors state:
  • The author stated that the Goldini et al study depended solely on clinical histories and questionnaires. It also included no evidence of typical clinical findings or tissue markers of asbestosis.
  • The author acknowledged that earlier RPF case series may have reported few asbestos-exposed patients because the importance of asbestos exposure was not well recognized.

Topics

Medical terms in this study, explained in our Lexicon: Fibrosis.

Related studies

• Asbestos and smoking as risk factors for idiopathic retroperitoneal fibrosis: a case-control study — M. Goldoni, S. Bonini, et al. (2014)
• Idiopathic retroperitoneal fibrosis: prospective evaluation of incidence and clinicoradiologic presentation — E.F.H. van Bommel, I. Jansen, et al. (2009)
• Asbestos exposure as a risk factor for retroperitoneal fibrosis — T. Uibu, P. Oksa, et al. (2004)
• Idiopathic retroperitoneal fibrosis: an update for nephrologists — V. Raglianti, G.M. Rossi, et al. (2021)
• Retroperitoneal fibrosis: new insights into clinical presentation and diagnosis — A. Vaglio (2009)
• Asbestos exposure: a potential cause of retroperitoneal fibrosis — R. Sauni, P. Oksa, et al. (1998)

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