– Emergency management of a patient presenting with established renal failure requires relief of the obstruction by percutaneous nephrostomy or ureteric stenting.
– Replacement of fluid and electrolyte losses following relief of bilateral ureteric obstruction is vital due to the frequent post-obstructive diuresis.
– Assess with daily weighing and measurement of blood pressure lying and standing.
– Steroids may decrease the oedema often associated with RPF and in this way help reduce the obstruction. If used, they are usually discontinued when inflammatory markers return to normal. The anti-oestrogen tamoxifen and cyclophosphamide have been used successfully in some patients.
– Surgical ureterolysis with omental wrap is often necessary to free and insulate the ureters from the encasing fibrous tissue.
– Biopsies are taken to exclude malignancy.
– Monitor for recurrent disease with serum creatinine and ultrasound 3 – 6 monthly for 5 years.