European Journal of Internal Medicine最新文献

{"title":"From words to biomarkers: Why PEth should enter clinical practice when assessing the risk of venous thromboembolism.","authors":"Elena Campello, Erika Zola, Paolo Simioni","doi":"10.1016/j.ejim.2025.106560","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.106560","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":"106560"},"PeriodicalIF":6.1,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145368975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary management of advanced chronic kidney disease: An evidence-based review.","authors":"Lyle W Baker, Cene Ovincy, Levon Souvalian, LaTonya J Hickson, Fouad T Chebib","doi":"10.1016/j.ejim.2025.106557","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.106557","url":null,"abstract":"<p><p>Chronic kidney disease (CKD) is a major contributor to global morbidity and mortality, traditionally managed through renin-angiotensin system (RAS) inhibition and supportive care. Recent therapeutic advances have transformed this landscape, offering targeted interventions that modify disease progression and improve cardiovascular and renal outcomes. This review summarizes emerging treatments across key domains of CKD management. Sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists have demonstrated robust cardiorenal benefits, particularly in patients with type 2 diabetes mellitus (T2DM). SGLT2 inhibitors are now widely used in CKD and heart failure, including among non-diabetic populations. GLP-1 receptor agonists are approved for T2DM and cardiovascular risk reduction, with recent expansion to CKD in T2DM. Nonsteroidal mineralocorticoid receptor antagonists (nsMRAs), particularly finerenone, provide additional cardiorenal protection with a lower risk of hyperkalemia than traditional steroidal agents. In autosomal dominant polycystic kidney disease (ADPKD), tolvaptan remains the only approved disease-modifying therapy, with clinical trials and real-world data supporting its efficacy across a range of disease stages. Emerging regenerative strategies, including mesenchymal stem cell (MSC) therapy and xenotransplantation using genetically modified pig kidneys, have shown early promise in preclinical models and limited human studies. While further research is needed to optimize patient selection and long-term outcomes, these approaches represent important future directions in nephrology. Together, these developments mark a shift toward mechanism-based, precision therapies in CKD care. Internal medicine clinicians are pivotal in identifying appropriate candidates for these treatments and integrating evolving evidence into practice to improve patient outcomes.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":"106557"},"PeriodicalIF":6.1,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145356651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ANCA-associated vasculitis and interstitial lung disease: challenges and open questions.","authors":"Sergio Prieto-González, Raül Jordà-Sánchez, Fernanda Hernández-González, Rona M Smith, David Rw Jayne","doi":"10.1016/j.ejim.2025.106553","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.106553","url":null,"abstract":"<p><p>Interstitial lung disease (ILD) is increasingly recognized as a common manifestation in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), particularly in patients with microscopic polyangiitis and myeloperoxidase (MPO)-ANCA. Its pathogenesis mainly involves MPO-ANCA production, oxidative stress, the formation of neutrophil extracellular traps, and genetic predisposition. The occurrence of ILD has major impacts on patients' quality of life and mortality risk. Usual interstitial pneumonia is reported as the most common CT pattern, and it is specifically associated with a poor prognosis. Treatment should be individualized, including immunosuppression, and antifibrotic therapy for progressive fibrosis, though the optimal management approach presently remains uncertain.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":"106553"},"PeriodicalIF":6.1,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Crystal clear - Part II: the role of uric acid in cardiorenal disease.","authors":"Claudio Borghi, Federica Fogacci, Arrigo Fg Cicero","doi":"10.1016/j.ejim.2025.106554","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.106554","url":null,"abstract":"<p><p>Building on the foundational mechanistic and epidemiological knowledge from Part I, this second part of the review further unpacks the cardiovascular implications of abnormalities in serum levels of uric acid (UA). With a focus on hypertension, coronary artery disease (CAD), heart failure (HF), stroke, and peripheral artery disease (PAD), we provide a nuanced synthesis of how elevated serum UA influences disease risk and clinical outcomes. We describe mechanistic pathways including endothelial dysfunction, vascular smooth muscle proliferation, oxidative stress, inflammation, and renin-angiotensin system activation. Large cohort studies demonstrate linear or U-shaped relationships between serum UA (SUA) and cardiovascular events, with risk often appearing below conventional hyperuricemia thresholds. We also analyze interventional evidence for UA-lowering treatments such as xanthine oxidase inhibitors, urate transporter 1 (URAT-1) inhibitors and sodium-glucose transport protein 2 (SGLT2), highlighting context-dependent benefits in patients with hypertension or heart failure, both with and without preserved ejection fraction. Importantly, we discuss sex differences, kidney function influence, and the U-shaped association seen in men. Finally, we argue that SUA should be integrated into cardiovascular risk stratification, potentially serving as both a biomarker and a therapeutic target, while recognizing the need for personalized approaches based on comorbidities and biochemical profiles. This completes the two-part series by bridging mechanistic insights with practical clinical implications.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":"106554"},"PeriodicalIF":6.1,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145330641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between long-term exposure to PM₁₀ and metabolic dysfunction-associated steatotic liver disease (MASLD) in subjects with disturbed metabolic homeostasis and genotypes at risk.","authors":"Agostino Di Ciaula, Marcin Krawczyk, Susanne N Weber, Mohamad Khalil, Jerlin Stephy JohnBritto, Hala Abdallah, Piero Portincasa","doi":"10.1016/j.ejim.2025.106555","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.106555","url":null,"abstract":"<p><strong>Background: </strong>Poor information exists on the role of air pollutants as possible predictors of liver fat over-storage in subjects with increased clinical and genetic risk for MASLD.</p><p><strong>Methods: </strong>In 140 cardio-metabolic patients we assessed Hepatic Steatosis Index (HSI), grading of MASLD, gene variants MBOAT7 rs641738, PNPLA3 rs738409, TM6SF2 rs58542926, diet and exposure to particulate matter <10 µm (PM₁₀) and to nitrogen dioxide (NO₂) in the prior 6 months.</p><p><strong>Results: </strong>About two-thirds of patients had MASLD. HSI depended on PM₁₀ but not on NO₂ levels. A stepwise backward regression confirmed sex, age, waist circumference, type 2 diabetes as significant predictors of the HSI in the whole group. Exposure to PM₁₀ was an additional predictor only in subjects with homozygous mutations. Carriers of homozygous variants showed the highest HSI, rate and grade of steatosis when living in areas with the highest exposure to PM₁₀, as compared with wild-type or heterozygous subjects. Generalized additive models showed a nonlinear association between HSI and PM₁₀ levels in the whole group and in subjects with- but not in those without homozygous variants. In patients with homozygous SNPs, HSI was negatively correlated with the adherence to Mediterranean diet.</p><p><strong>Conclusions: </strong>Mild chronic exposure to PM₁₀ is as an additional, independent predictor of liver fat over-storage in subjects with cardio-metabolic disorders and with increased genetic risk for MASLD. Besides specific genotypes and phenotypes, chronic exposure to PM₁₀ should be also taken into account in future studies considering risk stratification, and in selecting subjects with MASLD for inclusion in clinical trials.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":"106555"},"PeriodicalIF":6.1,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145330643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing invasive fungal infections in critical illness: reflections on recent American Thoracic Society recommendations.","authors":"Claudia Bartalucci, Jon Salmanton-García, Antonio Vena","doi":"10.1016/j.ejim.2025.106549","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.106549","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":"106549"},"PeriodicalIF":6.1,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the concordance between clinical diagnosis and biopsy in cutaneous vasculitis.","authors":"Deiner-Yivelson Muñoz-Delgado, Julián-Esteban Barahona-Correa, Daniela Meléndrez-Vásquez, Isabel-Cristina Cuellar-Ríos, Martín-Alonso Rondón-Sepúlveda, Daniel G Fernández-Ávila, Santiago Bernal-Macías","doi":"10.1016/j.ejim.2025.106550","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.106550","url":null,"abstract":"<p><strong>Objective: </strong>Cutaneous vasculitis poses a diagnostic challenge due to its variable presentations and overlap with other dermatologic conditions. Although biopsy is essential for confirmation, the concordance between clinical suspicion and histopathological findings remains uncertain. This study aimed to assess the agreement between the diagnostic impression of specialists and biopsy-confirmed vasculitis in adults.</p><p><strong>Patients and methods: </strong>This retrospective study analyzed 200 patients who underwent skin biopsy at a tertiary care hospital in Colombia between February 2017 and December 2024. Patients were classified according to clinical suspicion of vasculitis by dermatologists or rheumatologists. Researchers collected and analyzed clinical features and histopathological findings. Concordance between clinical and histopathological findings was assessed using Cohen's kappa coefficient.</p><p><strong>Results: </strong>Of the 200 patients, 107 had clinical suspicion of vasculitis. Mean age was 46.9 years, with 55.5 % females. Vasculitis was confirmed histologically in 80 (74.7 %) of those with clinical suspicion, and in 19 (20.4 %) of those with alternative clinical diagnoses. Small vessel vasculitis predominated (87.8 %), followed by medium-sized and mixed vessel involvement. Concordance analysis revealed moderate agreement between clinical suspicion and histopathological confirmation for the group of specialists (κ= 0.54; 95 % CI: 0.40 to 0.67). No significant association was found between specialist experience and diagnostic agreement in vasculitis. Inflammatory biomarkers were similar among patients with or without confirmed vasculitis.</p><p><strong>Conclusions: </strong>This study highlights the low diagnostic agreement between clinical and biopsy- confirmed vasculitis, emphasizing and highlighting the need for biopsy collection as a diagnostic tool. Paraclinical tests do not appear to be decisive for performing skin biopsy.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":"106550"},"PeriodicalIF":6.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left ventricular remodeling in IgA nephropathy: Prognostic implications and clinical correlations: LV remodeling in patients with IgAN.","authors":"Lu-Hua Jin, Qian Zhou, Gui-Xin Huang, Yi-Qin Wang, Peng-An Li, Li Tan, Wei Chen, Qiong Wen","doi":"10.1016/j.ejim.2025.106543","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.106543","url":null,"abstract":"<p><strong>Background: </strong>The determinants and prognosis of left ventricular (LV) geometric remodeling remain uncharacterized in immunoglobulin A nephropathy (IgAN). We investigated the (1) clinicopathological correlates of LV hypertrophy (LVH), (2) longitudinal evolution of LV geometry, and (3) associations of LVH phenotypes with cardiorenal outcomes.</p><p><strong>Methods: </strong>In this retrospective study, 683 adults with biopsy-proven primary IgAN (2013-2021) underwent comprehensive echocardiographic phenotyping. Multivariable Cox regression modeled associations of baseline LV geometry with a composite renal endpoint (50 % estimated glomerular filtration rate [eGFR] decline or kidney failure) and a cardiovascular endpoint (major adverse cardiovascular events [MACE]).</p><p><strong>Results: </strong>Among 683 patients, 60 (8.8 %) had LVH at baseline. Age, hypertension, proteinuria, eGFR, and arteriolar hyalinosis were significant risk factors for LVH. Hemoglobin (hazard ratio = 1.03, P = 0.043) and endocapillary hypercellularity (hazard ratio = 2.87, P = 0.017) were significant risk factors for LVH deterioration. The most critical finding was that compared with normal LV geometry, concentric hypertrophy conferred a 4.14-fold renal risk (95 % confidence interval [CI]: 1.02-16.75, P = 0.047), while eccentric hypertrophy predicted a 3.42-fold MACE risk (95 % CI: 1.08-10.8, P = 0.036) independent of clinicopathological confounders.</p><p><strong>Conclusions: </strong>In IgAN, age, hypertension, proteinuria, eGFR, and arteriolar hyalinosis are risk factors for LVH, while hemoglobin and endocapillary hypercellularity accelerate LVH progression. The key finding was that concentric LV remodeling signals renal risk, whereas eccentric hypertrophy independently portends MACE.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":"106543"},"PeriodicalIF":6.1,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive impairment in familiar hypercholesterolemia: how much is vascular and how much is confounding?","authors":"Christian Messina","doi":"10.1016/j.ejim.2025.106547","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.106547","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":"106547"},"PeriodicalIF":6.1,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors of individual participant data meta-analyses must honor trialists' commitments to trial participants: a case study.","authors":"Rafael Dal-Ré","doi":"10.1016/j.ejim.2025.106548","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.106548","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":"106548"},"PeriodicalIF":6.1,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}