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Diabetic muscle infarction in end-stage renal disease: A scoping review on epidemiology diagnosis and treatment

机译:终末期肾脏疾病中的糖尿病性肌梗死:流行病学诊断和治疗的范围界定研究

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Diabetic muscle infarction (DMI) refers to spontaneous ischemic necrosis of skeletal muscle among people with diabetes mellitus, unrelated to arterial occlusion. People with DMI may have coexisting end-stage renal disease (ESRD) but little is known about its epidemiology and clinical outcomes in this setting. This scoping review seeks to investigate the characteristics, clinical features, diagnostic evaluation, management and outcomes of DMI among people with ESRD. Electronic database (PubMed/MEDLINE, CINAHL, SCOPUS and EMBASE) searches were conducted for (“diabetic muscle infarction” or “diabetic myonecrosis”) and (“chronic kidney disease” or “renal impairment” or “dialysis” or “renal replacement therapy” or “kidney transplant”) from January 1980 to June 2017. Relevant cases from reviewed bibliographies in reports retrieved were also included. Data were extracted in a standardized form. A total of 24 publications with 41 patients who have ESRD were included. The mean age at the time of presentation with DMI was 44.2 years. Type 2 diabetes was present in 53.7% of patients while type 1 in 41.5%. In this cohort, 60.1% were receiving hemodialysis, 21% on peritoneal dialysis and 12.2% had kidney transplantation. The proximal lower limb musculature was the most commonly affected site. Muscle pain and swelling were the most frequent manifestation on presentation. Magnetic resonance imaging (MRI) provided the most specific findings for DMI. Laboratory investigation findings are usually non-specific. Non-surgical therapy is usually used in the management of DMI. Short-term prognosis of DMI is good but recurrence occurred in 43.9%. DMI is an uncommon complication in patients with diabetes mellitus, including those affected by ESRD. In comparison with unselected patients with DMI, the characteristics and outcomes of those with ESRD are generally similar. DMI may also occur in kidney transplant recipients, including pancreas-kidney transplantation. MRI is the most useful diagnostic investigation. Non-surgical treatment involving analgesia, optimization of glycemic control and initial bed rest can help to improve recovery rate. However, recurrence of DMI is relatively frequent.
机译:糖尿病性肌梗塞(DMI)是指糖尿病患者中骨骼肌的自发性缺血性坏死,与动脉闭塞无关。 DMI患者可能患有并存的终末期肾病(ESRD),但在这种情况下对其流行病学和临床结局知之甚少。该范围回顾旨在调查ESRD患者中DMI的特征,临床特征,诊断评估,管理和结局。电子数据库(PubMed / MEDLINE,CINAHL,SCOPUS和EMBASE)进行了搜索(“糖尿病性肌梗死”或“糖尿病性肌坏死”)和(“慢性肾脏病”或“肾功能不全”或“透析”或“肾脏替代疗法”) (或“肾脏移植”)),从1980年1月至2017年6月。在检索到的报告中,还包括来自参考书目的相关案例。数据以标准化形式提取。总共包括24篇出版物,涉及41名患有ESRD的患者。出现DMI时的平均年龄为44.2岁。 2型糖尿病占53.7%,而1型糖尿病占41.5%。在该队列中,接受血液透析的占60.1%,接受腹膜透析的占21%,接受肾移植的占12.2%。下肢近端肌肉组织是最常受累的部位。肌肉疼痛和肿胀是最常见的表现。磁共振成像(MRI)为DMI提供了最具体的发现。实验室调查结果通常是非特异性的。非手术疗法通常用于DMI的管理中。 DMI的短期预后良好,但复发率为43.9%。 DMI是糖尿病患者(包括受ESRD影响的患者)的罕见并发症。与未选择的DMI患者相比,ESRD患者的特征和结局通常相似。 DMI也可能发生在肾脏移植受者中,包括胰腺-肾脏移植。 MRI是最有用的诊断研究。非手术镇痛,优化血糖控制和卧床休息可以帮助提高康复率。但是,DMI的复发相对频繁。

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