Kircelli Fatih, Gunduz Mehmet, Gungor Ozkan, Ok Ercan
Division of Nephrology, Yozgat State Hospital, Yozgat, Turkey.
Hemodial Int. 2012 Jul;16(3):435-7. doi: 10.1111/j.1542-4758.2011.00636.x. Epub 2011 Nov 11.
Obesity is a major health problem that has entered the nephrology community and is challenging our conventional management strategies. In this case report, we present a morbidly obese dialysis patient whom dry-weight assessment was disturbed by excess epicardial fat mass due to obesity. This case suggests that problems related to obesity seem not to be limited to dealing with obesity-associated kidney injury, chronic kidney disease and mortality, but also other concepts in nephrology such that, as described, excess epicardial fat mass related to morbid obesity in this patient erroneously suggested a high cardiothoracic index, and misled patient management. Interpretation of chest X-ray in dry-weight assessment should take into account the patient's body weight especially in obese cases and alternative diagnostic methods for correct determination of fluid status are highly needed.
肥胖是一个已进入肾脏病学界的主要健康问题，正在挑战我们的传统管理策略。在本病例报告中，我们介绍了一名病态肥胖的透析患者，其干体重评估因肥胖导致的心外膜脂肪过多而受到干扰。该病例表明，与肥胖相关的问题似乎不仅限于肥胖相关的肾损伤、慢性肾脏病和死亡率，还涉及肾脏病学中的其他概念，例如，如所述，该患者因病态肥胖导致的心外膜脂肪过多错误地提示心胸指数升高，并误导了患者管理。在干体重评估中解读胸部X光片时应考虑患者体重，尤其是在肥胖病例中，并且非常需要用于正确确定液体状态的替代诊断方法。
