Innere Medizin (Heidelberg, Germany)最新文献

{"title":"[Surrogate markers in chronic kidney disease : Estimated glomerular filtration rate and albuminuria in clinical practice and in studies].","authors":"Jan Galle, Thomas Ebert, Martina Guthoff, Ulrich Kintscher, Katharina Marx-Schütt, Christoph Wanner","doi":"10.1007/s00108-026-02131-3","DOIUrl":"10.1007/s00108-026-02131-3","url":null,"abstract":"<p><strong>Background: </strong>With decreasing estimated glomerular filtration rate (eGFR) and increasing albuminuria, the risk of cardiovascular events and overall mortality increases in chronic kidney disease (CKD). Established clinical renal endpoints often correspond to the late stage of CKD. Early stages are often initially asymptomatic.</p><p><strong>Objective: </strong>This article classifies the eGFR progression and changes in albuminuria as early markers and possible surrogate endpoints in CKD studies and describes key aspects for their clinical and methodological use in studies and benefit assessment.</p><p><strong>Results: </strong>The eGFR and the urine albumin-creatinine ratio (UACR) are complementary for risk stratification and progress monitoring, including in the cardiorenal context. Variability and influencing factors such as volume status, infections and blood pressure necessitate repeated measurements and contextual interpretation, especially in heart failure and after initiation of treatment with acute effects. For the eGFR Slope, a distinction is made between total Slope over several years and chronic Slope after the early acute phase. A meta-analysis of randomized studies reported a strong association between the total Slope averaged over 3 years and renal endpoints with a median R² of 0.97, while the predictive accuracy of the chronic eGFR Slope was lower. Concerning albuminuria, it has been shown that higher UACR values are independently associated with cardiovascular mortality and that a reduction in UACR is associated with a more favorable renal prognosis.</p><p><strong>Conclusion: </strong>The progression of the eGFR and albuminuria can improve the practicality of studies in early stages of CKD, lead to faster results and facilitate interdisciplinary classification if validation, time window, acute phase, standard treatment and competing risks are reported in a comprehensible manner.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":"918-925"},"PeriodicalIF":0.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Amyloidosis: classification, diagnosis, and treatment].","authors":"Kiavasch M N Farid, Stefan Schönland, Norbert Blank, Fabian Aus dem Siepen, Markus Weiler, Jörg Beimler, Ute Hegenbart","doi":"10.1007/s00108-026-02130-4","DOIUrl":"10.1007/s00108-026-02130-4","url":null,"abstract":"<p><p>Amyloidoses are rare protein-misfolding disorders characterized by the deposition of insoluble fibrillar aggregates, leading to potentially life-threatening organ damage. These deposits can be systemic or localized. Systemic amyloidoses are often associated with monoclonal gammopathies, chronic inflammatory conditions, or have a hereditary origin. Treatment strategies primarily focus on reducing the production of amyloidogenic proteins-depending on the specific protein and its origin-through therapies such as chemotherapy, anti-inflammatory agents, or gene-silencing approaches. Early diagnosis is crucial to prevent progressive organ dysfunction. Over the past 25 years, significant advances in the diagnosis and therapeutic management of amyloidosis have been made.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":"882-891"},"PeriodicalIF":0.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Infection with Orientia tsutsugamushi and hospital-acquired pneumonia].","authors":"Ilka Grewe, Saskia Winzer, Silja Steinmann, Paul Francke, Aiman Gamal Abdelrahim, Annette Hennigs, Marylyn M Addo, Michael Ramharter, Dominic Wichmann, Stefan Schmiedel","doi":"10.1007/s00108-026-02124-2","DOIUrl":"10.1007/s00108-026-02124-2","url":null,"abstract":"<p><strong>Background: </strong>Tsutsugamushi fever is an infection caused by Orientia tsutsugamushi that is rarely diagnosed in Europe but endemic in several Asian countries and in Chile. Its clinical presentation is often nonspecific, ranging from fever, myalgia, lymphadenopathy, and a maculopapular rash to severe disease with multiorgan involvement.</p><p><strong>Case report: </strong>A 34-year-old man presented with fever, myalgia, lymphadenopathy, and a maculopapular rash after returning from Thailand. Despite empiric antimicrobial therapy, his condition deteriorated rapidly, with respiratory failure, decreased vigilance, and hypotension. PCR testing from peripheral blood confirmed Orientia tsutsugamushi. Treatment with doxycycline, along with meropenem for hospital-acquired pneumonia, resulted in rapid clinical improvement.</p><p><strong>Conclusions: </strong>This case highlights the importance of considering tsutsugamushi fever in febrile travellers returning from endemic regions. Early presumptive or PCR-based diagnostics and initiation of effective therapy are crucial to prevent severe disease with multiorgan involvement and secondary complications.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":"926-929"},"PeriodicalIF":0.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147950377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Update coronary artery disease].","authors":"Sven Wassmann","doi":"10.1007/s00108-026-02118-0","DOIUrl":"10.1007/s00108-026-02118-0","url":null,"abstract":"<p><p>Atherosclerotic cardiovascular diseases, such as coronary artery disease, are still the main cause of global mortality. This article discusses recent clinical trials and guidelines regarding hypercholesterolemia, prevention, revascularization and pharmacotherapy of coronary artery disease.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":"843-851"},"PeriodicalIF":0.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147847016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Computed tomography in cardiology: its necessity and developments].","authors":"Philipp Breitbart, Eleni Giokoglu, Emina Yikit, Thomas Voigtländer, Axel Schmermund","doi":"10.1007/s00108-026-02153-x","DOIUrl":"10.1007/s00108-026-02153-x","url":null,"abstract":"<p><p>Cardiac computed tomography angiography (CCTA) has evolved in recent years into a central pillar of non-invasive cardiovascular diagnostics and is now firmly established in both clinical guidelines and everyday practice. In particular, it plays a key role as a first-line modality for ruling out coronary artery disease in patients with low to intermediate pretest probability. In the acute setting, it can also be used in selected patient populations for rapid and reliable exclusion of disease, thereby improving patient management in the emergency department. Beyond the assessment of luminal stenosis, CCTA enables a comprehensive characterization of coronary atherosclerosis. Plaque volume and composition have emerged as key prognostic factors. Modern post-processing techniques allow for increasingly standardized and quantitative analyses, supporting individualized risk stratification and treatment planning. Notably, the detection of subclinical atherosclerosis can facilitate early initiation of preventive strategies and improve patient adherence to therapy. Technological advances such as photon-counting CT, and AI-based plaque analysis have significantly expanded diagnostic capabilities. In addition, CCTA plays an important role in patients after revascularization and in the planning and follow-up of structural heart interventions. Overall, it represents a powerful and versatile imaging modality that substantially enhances diagnosis, risk assessment, and therapeutic decision-making in modern cardiology.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148431699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Cardiovascular magnetic resonance imaging: routine use in cardiology and unique strengths].","authors":"Alexander Schulz, Theresa Reiter","doi":"10.1007/s00108-026-02152-y","DOIUrl":"10.1007/s00108-026-02152-y","url":null,"abstract":"<p><p>Cardiovascular magnetic resonance (CMR) has evolved over the past two decades into a central component of modern cardiology diagnostics. Its particular strength lies in the unique combination of highly accurate functional assessment and non-invasive tissue characterization within a single examination. The indications for CMR in contemporary clinical practice are broad. In the evaluation of coronary artery disease, stress perfusion CMR enables reliable assessment of myocardial ischemia and complements this with simultaneous viability analysis using late gadolinium enhancement (LGE). In inflammatory myocardial diseases, CMR, based on the Lake Louise criteria, allows differentiation between acute and chronic injury and supports therapeutic decision-making. In the assessment of unexplained left ventricular hypertrophy, CMR provides decisive insights for differential diagnosis through mapping techniques and characteristic tissue patterns, for example in amyloidosis or hypertrophic cardiomyopathy. It also plays a key role in heart failure by contributing to etiological clarification and prognostic assessment. Additional important applications include genetic and arrhythmogenic cardiomyopathies, where CMR enables detailed evaluation of morphology, biventricular function, and fibrofatty myocardial remodeling, as well as valvular heart disease, where it allows precise quantification of regurgitant volumes, flow, and ventricular volumes, particularly when echocardiography is limited. Further indications include cardiac masses, congenital heart disease, and transplant cardiology. Overall, CMR provides an integrated, precise, and non-invasive diagnostic approach that reduces diagnostic uncertainty, improves risk stratification, and supports clinical decision-making. Future developments, particularly in quantitative imaging, standardization, and the generation of robust clinical evidence, are expected to further strengthen its role in clinical care. This article follows an indication-based approach and provides practical guidance on clinical scenarios in which CMR should be considered.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Practical management of drug-induced long QT syndrome].","authors":"Pascal Syren, Patrick A Schweizer","doi":"10.1007/s00108-026-02151-z","DOIUrl":"https://doi.org/10.1007/s00108-026-02151-z","url":null,"abstract":"<p><p>Drug-induced long QT syndrome is a modifiable cause of fatal ventricular arrhythmias. Common drugs such as antiarrhythmics, psychotropic drugs, and antibiotics prolong the QTc interval via potassium channel (hERG/I_Kr) inhibition and promote torsade de pointes tachycardias. A prerequisite for the diagnosis is an accurate QTc measurement, which is associated with high error rates in automated analysis. In case of suspicion, manual QT measurement is advised, followed by the use of an appropriate formula for heart rate correction. Differential diagnosis should consider congenital long QT syndrome, electrolyte disturbances, intoxication, and structural heart disease, with diagnosis based on the modified Schwartz score. For medication lists and new therapies, drug lists and interaction analyses should be used, particularly to identify high-risk drug interactions such as psychotropic drugs combined with antibiotics and/or diuretics. In cases of increased risk at a QTc interval ≥ 500 ms, trigger substances must be immediately discontinued, and electrolyte, heart rate, and volume status normalized. In acute situations with torsade de pointes tachycardia, treatment using magnesium, isoproterenol, overdrive stimulation, and (if necessary) defibrillation is indicated. Follow-up electrocardiograms before, during, and (if discontinued due to QT prolongation) after therapy until QT normalization, avoidance of further trigger substances, regular follow-up controls, genetic counseling in the case of suspected congenital long QT syndrome, and comprehensive patient education form the basis of aftercare for this condition.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":""},"PeriodicalIF":0.6,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fortbildungen des BDI.","authors":"","doi":"10.1007/s00108-026-02149-7","DOIUrl":"https://doi.org/10.1007/s00108-026-02149-7","url":null,"abstract":"","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":"67 7","pages":"782-786"},"PeriodicalIF":0.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Zukunft der Selbstverwaltung.","authors":"","doi":"10.1007/s00108-026-02147-9","DOIUrl":"https://doi.org/10.1007/s00108-026-02147-9","url":null,"abstract":"","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":"67 7","pages":"772-781"},"PeriodicalIF":0.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Metabolic bone disorders: what the internist must not overlook].","authors":"Heide Siggelkow, Elena Tsourdi","doi":"10.1007/s00108-026-02136-y","DOIUrl":"10.1007/s00108-026-02136-y","url":null,"abstract":"<p><strong>Background: </strong>Metabolic bone disorders are common, albeit underestimated, causes of fractures and chronic bone pain in internal medicine. They can remain asymptomatic for long periods and are frequently only diagnosed when insufficiency fractures occur.</p><p><strong>Aim of the study: </strong>The aim of this review article is to discuss common and rare metabolic bone disorders and to outline a practice-oriented diagnostic approach.</p><p><strong>Materials and methods: </strong>Narrative review of current literature with particular emphasis on clinically relevant differential diagnoses and diagnostic algorithms.</p><p><strong>Results: </strong>In addition to secondary osteoporosis, disorders of calcium and phosphate metabolism play a central role. Important differential diagnoses include primary hyperparathyroidism, genetic osteopathies, hypophosphatasia, and fibroblast growth factor 23 (FGF23)-mediated hypophosphataemia. Crucial for diagnosis are a structured medical history, the measurement of calcium, phosphate, magnesium, parathyroid hormone and alkaline phosphatase, as well as, where necessary, further parameters such as tubular maximum for phosphate reabsorption per glomerular filtration rate (TMP/GFR) and FGF23. Magnetic resonance imaging is essential for detecting insufficiency fractures.</p><p><strong>Conclusion: </strong>A systematic approach to the diagnosis of metabolic bone diseases is crucial, as this directly determines different therapeutic implications, and specific treatment options are increasingly becoming available.</p>","PeriodicalId":73385,"journal":{"name":"Innere Medizin (Heidelberg, Germany)","volume":" ","pages":"709-716"},"PeriodicalIF":0.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148207063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}