Research

Asbestos-related pleural and lung fibrosis in patients with retroperitoneal fibrosis

Toomas Uibu¹ , Ritva Järvenpää¹ , Jari Hakomäki¹ , Anssi Auvinen² , Eero Honkanen³ , Kaj Metsärinne⁴ , Pekka Roto⁵ , Heikki Saha¹ , Jukka Uitti⁶ and Panu Oksa⁶

¹Departments of Respiratory Medicine, Radiology, and Internal Medicine, Tampere University Hospital, Tampere, Finland

²Tampere School of Public Health, University of Tampere, Tampere, Finland

³Department of Medicine, Division of Nephrology, Helsinki University Central Hospital, Helsinki, Finland

⁴Department of Internal Medicine, Turku University Hospital, Turku, Finland

⁵Finnish Health Centers LTD, Tampere, Finland

⁶Clinic of Occupational Medicine, Tampere University Hospital and Finnish Institute of Occupational Health Tampere, Finland

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Orphanet Journal of Rare Diseases 2008, 3:29doi:10.1186/1750-1172-3-29

Published:	13 November 2008

Abstract

Background

Retroperitoneal fibrosis (RPF) is a rare fibroinflammatory disease that leads to hydronephrosis and renal failure. In a case-control study, we have recently shown that asbestos exposure was the most important risk factor for RPF in the Finnish population. The aim of this study was to evaluate the relation of asbestos exposure to radiologically confirmed lung and pleural fibrosis among patients with RPF.

Methods

Chest high-resolution computed tomography (HRCT) was performed on 16 unexposed and 22 asbestos-exposed RPF patients and 18 asbestos-exposed controls. Parietal pleural plaques (PPP), diffuse pleural thickening (DPT) and parenchymal fibrosis were scored separately.

Results

Most of the asbestos-exposed RPF patients and half of the asbestos-exposed controls had bilateral PPP, but only a few had lung fibrosis. Minor bilateral plaques were detected in two of the unexposed RPF patients, and none had lung fibrosis. DPT was most frequent and thickest in the asbestos-exposed RPF-patients. In three asbestos-exposed patients with RPF we observed exceptionally large pleural masses that were located anteriorly in the pleural space and continued into the anterior mediastinum.

Asbestos exposure was associated with DPT in comparisons between RPF patients and controls (case-control analysis) as well as among RPF patients (case-case analysis).

Conclusion

The most distinctive feature of the asbestos-exposed RPF patients was a thick DPT. An asbestos-related pleural finding was common in the asbestos-exposed RPF patients, but only a few of these patients had parenchymal lung fibrosis. RPF without asbestos exposure was not associated with pleural or lung fibrosis. The findings suggest a shared etiology for RPF and pleural fibrosis and furthermore possibly a similar pathogenetic mechanisms.