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Two men aged 58 and 76, respectively, presented with fatigue and loss of appetite followed by anuria. Laboratory tests showed anaemia, elevated ESR and renal failure. CT of the abdomen revealed obstruction of the ureters by retroperitoneal fibrosis. The first patient had retroperitoneal fibrosis in combination with an aneurysm of the aorta; in the second patient, the image was suggestive of pancreatic carcinoma with secondary fibrosis, but eventually the retroperitoneal fibrosis proved to be idiopathic. Both patients were successfully treated with prednisone and temporary placement ofnephrostomy catheters. Retroperitoneal fibrosis is an often idiopathic disease that can cause compression of retroperitoneal structures such as the ureters. The clinical picture is aspecific so that the diagnosis is often delayed. Treatment with prednisone is preferable, followed by immunosuppressive therapy or tamoxifen in case of resistance to steroids. Relief of the obstruction by means of temporary nephrostomy catheters often makes surgery unnecessary. Retroperitoneal fibrosis is an uncommon disease that deserves more attention in view ofthe favourable therapeutic options following timely diagnosis.

In a 14-year-old girl who suffered from anuria and abdominal pain, atresia of the hymen was diagnosed.

A 49-year-old man was admitted because of acute anuria. He had bilateral loin pain and was said to have been suffering from renal calculi seven years earlier. He used diclofenac as a pain killer. The renal pyela were mildly dilated. Eventually it became clear that the patient suffered from retroperitoneal fibrosis. This case illustrates (a) ureteral patency does not ensure actual urine flow; (b) non-steroidal anti-inflammatory drugs (NSAIDs) are a frequent cause of renal function loss, but only if there is an additional renal disease causing increased renal prostaglandin synthesis; (c) pattern recognition and verification are clinically relevant diagnostic tools.

In a 61-year-old man, who had undergone left-sided nephrectomy in the past, and who came with anuria and recurrent pulmonary oedema, complete obstruction of the right renal artery was diagnosed. Recurrent pulmonary oedema may be a manifestation of ischaemic renal disease. This clinical entity is not rare and may lead to terminal renal insufficiency. Both surgery and angioplasty can preserve or improve renal function and make dialysis therapy unnecessary. In the patient described, the stenotic part of the renal artery was resected and the vessel connected to the aorta end to side; the patient recovered.