Diabetes mellitus(DM)is defined as a chronic disease of disordered metabolism with an ongoing increase in prevalence and incidence rates.Renal disease in patients with diabetes is associated with increased morbidity a...Diabetes mellitus(DM)is defined as a chronic disease of disordered metabolism with an ongoing increase in prevalence and incidence rates.Renal disease in patients with diabetes is associated with increased morbidity and premature mortality,particularly attributed to their very high cardiovascular risk.Since this group of patients frequently lacks specific symptomatology prior to the adverse events,a screening tool for the identification of high-risk patients is necessary.The epicardial adipose tissue(EAT)is a biologically active organ having properties similar to visceral adipose tissue and has been associated with metabolic diseases and coronary artery disease.Superior to conventional cardiovascular risk factors and anthropometric measures,including body mass index and waist circumference,the EAT can early predict the development of coronary artery disease.Assessment of EAT can be performed by twodimensional echocardiography,magnetic resonance imaging or computer tomography.However,its role and significance in patients with DM and nephropathy has not been thoroughly evaluated.The aim of the current editorial is to evaluate all available evidence regarding EAT in patients with DM and renal impairment.Systematic search of the literature revealed that patients with DM and nephropathy have increased EAT measurements,uncontrolled underlying disease,high body mass index and raised cardiovascular risk markers.Acknowledging the practical implications of this test,EAT assessment could serve as a novel and non-invasive biomarker to identify high-risk patients for cardiovascular adverse events.展开更多
肾血管平滑肌脂肪瘤(angiomyolipoma,AML)是泌尿系统常见的良性肿瘤,主要由脂肪组织、血管及肌肉组织构成。肾AML可同时合并结节性硬化症,但多数为散发,好发于中年女性,无明显临床症状,可由影像学检查检出。典型AML在CT平扫上具有特征...肾血管平滑肌脂肪瘤(angiomyolipoma,AML)是泌尿系统常见的良性肿瘤,主要由脂肪组织、血管及肌肉组织构成。肾AML可同时合并结节性硬化症,但多数为散发,好发于中年女性,无明显临床症状,可由影像学检查检出。典型AML在CT平扫上具有特征性的脂肪密度,易与其他肾肿瘤相鉴别,但少部分AML含有极少量或不含有脂肪成分,平扫CT难以发现负值成分,称为乏脂型血管平滑肌瘤,其确诊依赖组织病理检查结果。另外,部分AML具有恶性表象,可累及肾周、肾窦、淋巴结、其他内脏器官及下腔静脉,进一步增加了鉴别诊断的难度。目前国内尚未见乏脂型肾血管平滑肌脂肪瘤伴发淋巴结肿大的相关报道。本文报道1例27岁女性患者,无结节性硬化症家族史,初因CT发现左肾旁团块状高密度影及颈部、腋窝、腹股沟、腹腔及腹膜后多发淋巴结肿大就诊于血液科,考虑淋巴瘤可能,为明确诊断而转入泌尿外科行腹腔镜下左肾周肿物、腹膜后淋巴结切除术和活体组织检查,术后组织病理结果提示AML。患者术后并发持续性淋巴瘘,腹膜后引流乳糜液100~200 m L/d,持续12周,予禁食、补液等保守治疗措施后成功闭瘘。本文回顾了国内外的相关病例及文献,并对伴多发淋巴结肿大的肾AML诊断、治疗和术后顽固性淋巴瘘的处理进行总结和探讨。展开更多
文摘Diabetes mellitus(DM)is defined as a chronic disease of disordered metabolism with an ongoing increase in prevalence and incidence rates.Renal disease in patients with diabetes is associated with increased morbidity and premature mortality,particularly attributed to their very high cardiovascular risk.Since this group of patients frequently lacks specific symptomatology prior to the adverse events,a screening tool for the identification of high-risk patients is necessary.The epicardial adipose tissue(EAT)is a biologically active organ having properties similar to visceral adipose tissue and has been associated with metabolic diseases and coronary artery disease.Superior to conventional cardiovascular risk factors and anthropometric measures,including body mass index and waist circumference,the EAT can early predict the development of coronary artery disease.Assessment of EAT can be performed by twodimensional echocardiography,magnetic resonance imaging or computer tomography.However,its role and significance in patients with DM and nephropathy has not been thoroughly evaluated.The aim of the current editorial is to evaluate all available evidence regarding EAT in patients with DM and renal impairment.Systematic search of the literature revealed that patients with DM and nephropathy have increased EAT measurements,uncontrolled underlying disease,high body mass index and raised cardiovascular risk markers.Acknowledging the practical implications of this test,EAT assessment could serve as a novel and non-invasive biomarker to identify high-risk patients for cardiovascular adverse events.
文摘肾血管平滑肌脂肪瘤(angiomyolipoma,AML)是泌尿系统常见的良性肿瘤,主要由脂肪组织、血管及肌肉组织构成。肾AML可同时合并结节性硬化症,但多数为散发,好发于中年女性,无明显临床症状,可由影像学检查检出。典型AML在CT平扫上具有特征性的脂肪密度,易与其他肾肿瘤相鉴别,但少部分AML含有极少量或不含有脂肪成分,平扫CT难以发现负值成分,称为乏脂型血管平滑肌瘤,其确诊依赖组织病理检查结果。另外,部分AML具有恶性表象,可累及肾周、肾窦、淋巴结、其他内脏器官及下腔静脉,进一步增加了鉴别诊断的难度。目前国内尚未见乏脂型肾血管平滑肌脂肪瘤伴发淋巴结肿大的相关报道。本文报道1例27岁女性患者,无结节性硬化症家族史,初因CT发现左肾旁团块状高密度影及颈部、腋窝、腹股沟、腹腔及腹膜后多发淋巴结肿大就诊于血液科,考虑淋巴瘤可能,为明确诊断而转入泌尿外科行腹腔镜下左肾周肿物、腹膜后淋巴结切除术和活体组织检查,术后组织病理结果提示AML。患者术后并发持续性淋巴瘘,腹膜后引流乳糜液100~200 m L/d,持续12周,予禁食、补液等保守治疗措施后成功闭瘘。本文回顾了国内外的相关病例及文献,并对伴多发淋巴结肿大的肾AML诊断、治疗和术后顽固性淋巴瘘的处理进行总结和探讨。
