Deutsche medizinische Wochenschrift (1946)最新文献

The examination of urine and its evaluation are central components in the diagnostic pathway for kidney diseases. Essential to this process is the correct analysis and interpretation of the urine sediment. A nephritic sediment indicates glomerular kidney disease with high specificity. This article explains the diagnosis, evaluation, and implications of a nephritic sediment.

Anamnesis and clinical examination: A 59-year-old female patient with an unremarkable medical history presented with watery diarrhea, severe lower abdominal pain, and fever for approximately 7 days. Physical examination revealed a distended abdomen, bowel sounds were absent, and there was an acute abdomen with generalized guarding and significantly elevated inflammatory markers.

Diagnosis: Abdominal computed tomography showed significant ascites and signs of peritonitis. Exploratory diagnostics were indicated. A laparoscopy was performed, which revealed diffuse purulent peritonitis. Organ perforation or other reasons for a peritonitis were excluded.

Therapy and clinical course: Bacteriological examination and blood cultures showed β-hemolytic group A streptococci, leading to the diagnosis of spontaneous bacterial peritonitis caused by streptococci. The patient was treated with antibiotics, progressively recovered, and was discharged symptom-free and without sequelae.

Conclusion: Primary spontaneous bacterial peritonitis caused by Streptococcus pyogenes is a rare cause of acute abdomen. An early diagnosis and immediate antibiotic therapy are crucial for prognosis.

The article is based, among other things, on the updated KDIGO guideline for the evaluation and management of chronic kidney disease, which was published in Kidney International in March 2024. Chronic kidney disease is one of the most common chronic diseases, with a prevalence of around 10%, not least due to demographic ageing. The incidence of chronic kidney disease is approximately twice that of diabetes and approximately 20 times higher than that of cancer. Chronic kidney disease is classified using glomerular filtration rate and albuminuria. The definition of CKD may also include markers other than GFR and ACR. Patients with diabetes or hypertension should have GFR and ACR tested regularly. The individual risk of kidney failure requiring dialysis can be determined using a prediction equation. A better understanding of age- and gender-specific differences means that personalized therapy approaches are becoming increasingly important. Clinicians should be aware of the limitations of the endogenous biomarkers creatinine and cystatin C for determining GFR. For Germany, the equations of the European Kidney Function Consortium (EKFC) are recommended for estimating GFR.

This article provides an overview of treatment approaches for chronic kidney disease (CKD) in patients with IgA nephropathy (IgAN). IgAN is the most common primary glomerulonephritis and results from an autoimmune reaction to aberrantly glycosylated immunoglobulin A (IgA) antibodies. Although historically considered largely benign, it is now recognized that a significant percentage of patients develop dialysis-dependent kidney disease over the years. Traditional treatments with RAAS inhibitors and newer therapies such as SGLT2 inhibitors, endothelin receptor antagonists, and delayed release, primarily locally acting enteric corticosteroids regarding their role in reducing proteinuria and preserving kidney function are also discussed. Additionally, non-immunosuppressive options and lifestyle modifications are examined for their potential to slow disease progression. Further promising medications are currently in clinical trials, including complement inhibitors and immunomodulators. These emerging therapies offer hope for significantly improving the prognosis of IgAN in the future. By presenting a comprehensive overview of current and potential future treatment strategies, this review aims to provide clinicians with up-to-date information to optimize the management of CKD in patients with IgAN.

An acutely altered mental status is a common presenting complaint. A wide variety of neurological, systemic or psychiatric conditions can be the cause. Sometimes there is even overlap of various diseases that contribute to the patient's confusion. The brain can be primarily or secondarily involved. A meticulous history and examination provide the first clues as to the origin of the alternation in personality. Most of the time further exams at the hospital are necessary to determine the diagnosis and plan the treatment. Nevertheless, even with just limited preclinical resources perceptive teams are able to gather and analyse enough information to diagnose and treat the patient. The result of this detective work can be quite rewarding, especially if the initial diagnosis is confirmed. Therapeutic measures preclinically focus on maintaining the cerebral equilibrium.

Since its founding 150 years ago, the Deutsche Medizinische Wochenschrift has continually followed the developments in nephrology through countless publications. Pioneers in nephrology like Franz Volhard and Georg Haas were authors of the DMW, and new hypotheses, examination methods, and therapies were often debated here, as this article shows.

The DMW is celebrating its 150th anniversary - and this period is precisely when endocrinology and diabetology evolved from the first experiments to molecular biology, genetic, and bioinformatics research. The DMW has always accompanied this process with numerous important publications, some of which are highlighted in this article.

The developments in intensive care medicine documented in the Deutsche Medizinische Wochenschrift over the decades have significantly improved survival rates in severe conditions and pushed the boundaries of what is possible in acute medicine. By analyzing past issues and articles, this article shows how the Deutsche Medizinische Wochenschrift has acted as a mirror of the dynamic landscape of intensive care medicine.

This article reflects 150 years of medical progress, particularly in internal medicine and cardiology, which have been accompanied and documented by the Deutsche Medizinische Wochenschrift (DMW). A fascinating look back at the exciting development of this specialist field and an outlook on future possibilities.