Lymphedema: An Overlooked Cause of Edema?

I applaud Dr Anil Mandal's 2 articleson edema (CONSULTANT, August2004, pages 1221 and 1245, respectively).However, discussion of lymphedemais noticeably absent. Accordingto the National Lymphedema Network(http://www.lymphnet.org), 2.5 million Americansare affected by this disabling condition. As a result ofadvances in cancer therapy, the incidence and prevalenceof this treatment sequela are rising.-- Bonnie Faherty, PhD, APRN, BC Cm
   Northridge, CalifThank you for your comments. Lymphedemawas not discussed because it is seldom consideredas part of the differential diagnosis in thepractice of nephrology. Anatomically, lymphaticvessels may be involved in the persistence ofedema. However, lymphedema proper is caused bylymphatic obstruction--by the intrinsic obstruction thatresults from filariasis (in tropical countries) or by theextrinsic obstruction that often results from enlargedlymph nodes or tumor.-- Anil K. Mandal, MD
   Clinical Professor of Medicine
   University of Florida College of Medicine
   Jacksonville