Journal Article

Value of acute-phase reactants in monitoring disease activity and treatment response in idiopathic retroperitoneal fibrosis

Lindsey G. Pelkmans, Albert-Jan L.H. Aarnoudse, Tadek R. Hendriksz and Eric F.H. van Bommel

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 27, issue 7, pages 2819-2825
Published in print July 2012 | ISSN: 0931-0509
Published online January 2012 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfr779
Value of acute-phase reactants in monitoring disease activity and treatment response in idiopathic retroperitoneal fibrosis

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Background

Prospective evaluation of the value of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels in monitoring disease activity and treatment response in patients with idiopathic retroperitoneal fibrosis (RPF).

Methods

This study included 57 patients with idiopathic RPF receiving tamoxifen monotherapy with at least 8 months follow-up. Clinical, laboratory and radiological investigation was performed at presentation and at repeated follow-up. Remission was defined as significant clinical improvement within 6 weeks of treatment together with stable or decreasing mass size on follow-up computed tomography (CT) scanning at 4 months and definitive decrease in mass size on follow-up CT scanning at 8 months.

Results

ESR and CRP levels at presentation and their respective decreases over time correlated strongly with each other (P < 0.001). Baseline ESR and CRP levels correlated with visual analogue scale (VAS) score for pain (ESR, P < 0.01; CRP, P < 0.001); baseline ESR levels also correlated with VAS score for discomfort (P < 0.001). Short-term decreases in ESR or CRP levels at 6 weeks follow-up did not correlate with subsequent mass regression but decrease in ESR at 4 months and decrease in CRP at 4 and 8 months follow-up correlated with mass regression. Kaplan–Meier analysis showed no difference in remission rate between patients with normal or elevated baseline ESR or CRP (log-rank P = 0.22/P = 0.88) or between patients with or without (near-)normalization of ESR or CRP in first 6 weeks of treatment (log-rank P = 0.12/P = 0.32).

Conclusions

Patients with idiopathic RPF who have elevated acute-phase reactant levels are more symptomatic. Neither acute-phase reactant levels or their initial changes can be taken as a major predictor for treatment success.

Keywords: Acute-phase reactants; disease activity; retroperitoneal fibrosis; Tamoxifen; treatment response

Journal Article.  4333 words.  Illustrated.

Subjects: Nephrology

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