Family doctor health management of a patient with idiopathic retroperitoneal fibrosis: case report
DOI:
https://doi.org/10.32385/rpmgf.v39i5.13003Keywords:
Retroperitoneal fibrosis, Family doctor, Disease management, Comorbidity, Case reportAbstract
Introduction: Retroperitoneal idiopathic fibrosis or Ormond’s disease posits as a diagnostic challenge in family and general medicine, leading the family doctor to an exploration and management of subsequent derangements in the control of comorbidities, in individuals with multi-pathology.
Case description: We describe an autonomous 79 years old widowed patient, with a higher socio-economic status. In a cardiovascular vigilance consultation, she refers to fatigue, abdominal distension, and hypogastric discomfort, accompanied by retrosternal pain for 15 days. The focused objective assessment highlights only hypogastric pain and discrete clogging in the transition between the left lumbar and iliac regions. Her blood samples presented normocytic normochromic anemia and inflammatory markers increase. Considering the clinical findings and analytic changes, we ordered complementary exams that showed bilateral pyelocaliceal dilatation and retroperitoneal fibrosis. The patient was referred to urology consultation, where it was decided to introduce bilateral double J catheters and corticosteroids. This deranged the pre-existent diseases of the patient with an emphasis on diabetes, with the need to initiate and manage insulin therapy. The new diagnosis and pre-existing conditions change lead to the patient’s instability, focusing on the family doctor for the necessary support and accompanying. With remission achievement, the double J catheters were removed, with subsequent relapse, that led to their replacement and corticosteroids reintroduction.
Comment: We highlight doctor-patient emotional and therapeutic sharing of the diagnosis of retroperitoneal idiopathic fibrosis, with decompensation of pre-existing condition and prevention of common side effects of the introduced therapy. The family doctor’s role of proximity and availability for the follow-up and careful screening of signs and markers of an idiopathic retroperitoneal fibrosis relapse constituted an anxiolytic factor for the patient. Effective communication between the different levels of care in the health system is still deficient and limits the integrated care of disease between the various stakeholders, pictured by the lack of information on the screening of other affected organs, in a possible systemic disease. This case, by the complexity of its management, highlights the role of the family doctor in its assorted skills, as defined by its world organization.
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References
Cristian S, Cristian M, Cristian P, Constantin G, Savu C, Huri E, et al. Management of idiopathic retroperitoneal fibrosis from the urologist’s perspective. Ther Adv Urol. 2015;7(2):85-99.
Runowska M, Majewski D, Puszczewicz M. Retroperitoneal fibrosis: the state-of-the-art. Reumatología. 2016;54(5):256-63.
Khosrhoshahi A, Carruthers MN, Stone JH, Shinagare S, Sainani N, Hasserjian RP, et al. Rethinking Ormond’s disease: “idiopathic” retroperitoneal fibrosis in the era of IgG4-related disease. Medicine (Baltimore). 2013;92(2):82-91.
Vaglio A, Maritati F. Idiopathic retroperitoneal fibrosis. J Am Soc Nephrol. 2016;27(7):1880-9.
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