Innere Medizin (Heidelberg, Germany)最新文献

Nephrotic syndrome (NS) is characterized by proteinuria > 3.5 g/day, hypoalbuminemia, peripheral edema, and hyperlipidemia. Common primary causes of NS are podocytopathies, such as minimal change nephropathy, focal segmental glomerulosclerosis, and membranous nephropathy. In a subset of patients with primary NS autoantibodies against podocyte antigens can be detected. Diabetes mellitus, amyloidosis, systemic lupus erythematosus, malignancies, infections, and medications are some of the numerous secondary causes of NS. Beside searching for secondary causes, a kidney biopsy is usually performed to define the entity of NS. Complications of NS include venous thrombosis, infections, and the development of acute or chronic kidney disease. Sodium restriction, loop diuretics, statins, possibly anticoagulation, and antiproteinuric therapy are important measure for supportive therapy in NS. In addition, immunosuppressive treatment is often required.

Organ transplantation is the treatment of choice for patients with end-stage organ failure. Sex/gender differences in transplantation are extremely relevant, yet understudied. They are significant for every step in the transplantation process: from evaluation, listing, and acceptance onto the waiting list, to transition from the waiting list to transplantation, and finally to short- and long-term transplant survival. Ultimately, sex/gender differences also affect patient survival. Registry analyses often consider sex and gender only as a modifying factor, and women are underrepresented in clinical trials in transplantation medicine. The causes of these differences include not only biological factors (sex), but also psychosocial, socioeconomic, and cultural factors (gender). The current lack of consideration of sex/gender-specific differences leads to disadvantages. More targeted basic and clinical research must contribute to understanding the underlying mechanisms of these differences and applying them in diagnostic and therapeutic approaches.

Medical follow-up after the transplantation of solid organs is a key component in ensuring long-term survival of both the graft and the patient. This article outlines the essential principles of post-transplant care for recipients of heart, liver, lung, and kidney transplants. Across all organ types, certain core elements are universally important: monitoring of graft function, individualized adjustment of immunosuppressive therapy, early detection and treatment of rejection episodes, consistent prevention, recognition, and management of infections, professional care for comorbidities, and appropriate cancer screening. Despite these shared principles, there are significant differences between the various organ transplants in terms of potential complications, immunological risks, and monitoring strategies. Successful long-term outcomes depend heavily on close collaboration between transplant centers, specialists in private practice, and general practitioners.

Background: Sudden cardiac death (SCD) is an unexpected natural death with a suspected cardiac cause, accounting for approximately 20% of all cardiovascular deaths in Germany. A significant proportion of SCD in young people (< 50 years) are caused by hereditary arrhythmogenic diseases.

Methods: The European Society of Cardiology (ESC) guidelines recommend autopsy in all cases of unexpected sudden death, especially in young people, and post-mortem genetic testing (molecular autopsy) if a hereditary heart disease is suspected. Several studies show that molecular autopsy reveals a clinically relevant sequence variant associated with an inherited arrhythmogenic disease in about 20% of cases. Clinical cardiological and genetic testing of biologically related relatives of the deceased can reduce the risk of further deaths within affected families.

Results and conclusion: Based on molecular autopsy and clinical and genetic examination of relatives, therapeutic and preventive measures can be taken within families affected by SCD. This requires a structured approach to an SCD case by various medical disciplines within a financial and legal framework that has yet to be established in the German healthcare system.

Background: Obesity affects a growing number of people worldwide and is associated with severe metabolic, cardiovascular and oncological complications. Obesity not only represents an individual health burden but is also a socioeconomic challenge. With the incretin mimetics liraglutide, semaglutide and tirzepatide, a new class of drugs is now available that for the first time enables substantial and clinically relevant weight reduction.

Objective: The article sheds light on the efficacy, safety and prospects of obesity treatment based on glucagon-like peptide 1 (GLP-1). In addition to the results of key clinical trials, potential risks, limitations of use, typical side effects and drug interactions are discussed. Economic aspects are also explained.

Results: Clinical trials show an average weight reduction of 15-20%, with tirzepatide in particular being highly effective. Positive side effects of the treatment mainly concern metabolism (prediabetes and type 2 diabetes regression) and cardiovascular diseases. The main side effects are the frequently occurring gastrointestinal disorders, such as nausea and vomiting. The long-term safety of the substances has not yet been conclusively proven. High costs, limited access and the potential for abuse pose additional challenges. Combination preparations and orally available drugs are currently under development.

Conclusion: Incretin mimetics represent a major advance in the treatment of obesity but require careful selection, close monitoring and long-term integration into lifestyle measures.

Organ transplantation in children and adolescents can be the optimal treatment for several diseases but poses unique medical and psychosocial challenges. These include differences in underlying conditions, infection risk, vaccination strategies, surgical complexity, growth and development issues, as well as family dependency. A crucial phase in the care of adolescent transplant recipients is the transition and transfer into adult medical care. The transition must be well-structured, individualized, and initiated early on to ensure long-term graft function and treatment adherence. Interdisciplinary collaboration, standardized protocols, and psychosocial support are essential for a successful transition and transfer to adult care.