Deutsche medizinische Wochenschrift (1946)最新文献

Artificial intelligence (AI) is rapidly reshaping medical diagnostics, and nephrology - characterized by multifactorial disease patterns - stands to benefit markedly. Machine‑learning and deep‑learning algorithms, especially convolutional neural networks (CNNs) and large language models (LLMs), can analyze heterogeneous data streams from electronic health records, imaging, histopathology and genomics to support diagnosis, prognosis and therapeutic planning. AI‑driven automation of routine workflows (e.g., appointment scheduling, NLP‑based documentation, chatbot‑guided anamneses) enables clinicians to focus on complex decision‑making, while real‑time decision‑support tools can integrate laboratory, imaging and guideline data. Recent advances include CNN‑based detection of renal lesions, deep‑learning prognostic scores for IgA nephropathy, and AI‑enhanced variant calling (e.g., DeepVariant). Nevertheless, challenges persist: data bias, limited external validation, "hallucinations" of LLMs, regulatory compliance (MDR, GDPR), and the need for transparent, locally hosted models. Successful implementation requires interoperable, FHIR‑compatible data, robust training of staff, and integration of AI education into medical education. With this, AI promises substantial efficiency gains, improved diagnostic precision, and sustained care quality in nephrology.

New guidelines and position papers on the management of infective endocarditis have led to discussions on specific statements. In the current position paper, the main controversies will be summarized and commented on from an infectious diseases perspective. Background information and an adaptation of the recommendations for the German setting will be provided. Important adjustments and changes appear to be necessary with regard to the diagnostic work-up, the indication for endocarditis prophylaxis and certain treatment recommendations. A major challenge concerning many recommendations is the very limited evidence from prospective clinical studies in the context of a complex clinical picture with diverse pathogens, varying severity, complication risks and both surgical and conservative treatment options. More clinical research and treatment studies are necessary, and interdisciplinary management is mandatory.

The recently updated guidelines on medical and surgical therapeutics of Crohn's disease issued by the European Crohn's and Colitis Organization (ECCO) critically review the various drug and surgical treatment approaches. To optimize the delivery of care and therapeutic endpoints, involvement of multidisciplinary teams and treat-to-target approaches are recommended. Conventional medical therapies have only limited relevance. 5-aminosalicylates should not be used and corticosteroids are at best suitable for short-term control of acute flares. The therapeutic benefit of thiopurines is viewed with caution due to potential side effects and their inferior efficacy compared to infliximab. Advanced therapies (antibodies and small molecules) should be selected with regard to individual patient factors. TNF antibodies continue to be a mainstay of Crohn's therapy. IL-23 antibodies appear to be effective alternatives following loss of response to TNF antibodies. Nutritional therapies have so far been given too little consideration in clinical practice. Exclusive enteral nutrition can be used in children or compliant adults. Other diets including Mediterranean diet can be applied to maintain remission. Surgical treatment of Crohn's disease may be increasingly used in early stages of the disease, as it can avoid long-term complications and medical therapies. Whenever possible, operations are performed laparoscopically, with preoperative conditioning (avoidance of corticosteroids, correction of malnutrition) playing a particularly important role.

Overweight and obesity pose significant challenges for the healthcare system. General practitioners in particular are in a good position to make important contributions to the prevention and management of obesity. The aim of the study was to determine the positions, attitudes and experiences, as well as the wishes for improvement of GPs with regard to obesity care.In the course of an online survey, a total of 4,038 GPs were surveyed between January and April 2024. In addition to the descriptive analysis, a t-test for independent samples was conducted to determine significant differences between 2 groups.GPs experience obesity as a significant challenge. When providing weight advice, they place particular importance on assessing the individual's life situation in order to better determine the causes and consequences of excess weight. While nutritional advice is provided by every second respondent, exercise advice is less common. Some make use of the opportunity to recommend specific health services to patients. In terms of therapeutic measures, the respondents place great emphasis on changing the diet, followed by questions of psychosocial support and physical activation. GPs are often not satisfied with the outcome of disease management. The respondents would like to see more sustainable interprofessional structures.The potential of primary care for obesity management is currently not being fully exploited. It seems sensible to raise awareness among GPs of the causes of obesity and to anchor a motivating, behavior-oriented conversation in a more efficient way. A diagnosis of obesity should be linked to concrete recommendations for action. GPs should be strengthened in their mediator role by integrating patients into a network of other support services as needed. The development of GP-compliant care programs for obesity management should be further promoted.

Non-tuberculous mycobacteria (NTM) are increasingly recognized as clinically relevant pathogens, particularly in countries with a low tuberculosis incidence. Recent data from Denmark demonstrate a continuous annual rise in NTM-related pulmonary disease (NTM-PD) of 4.6% over 3 decades, with more than half of the isolates associated with true disease. Structural lung diseases such as bronchiectasis, prior tuberculosis, and chronic pulmonary conditions are major risk factors, alongside immunodeficiencies and immunosuppressive therapies. The diagnosis of NTM-PD requires a combination of clinical symptoms, radiological findings, and the microbiological confirmation. Novel diagnostic tools, such as anti-GPL IgA serology and a CRISPR-Cas-based cfDNA assay, show promise for differentiating colonization from disease and monitoring treatment response, but the sputum culture remains essential for species identification and drug susceptibility testing. Treatment is complex and species-specific, with macrolides forming the backbone of most regimens. Refractory cases, particularly those involving Mycobacterium abscessus, pose therapeutic challenges and often require multidisciplinary management. Inhaled liposomal amikacin (ALIS) has shown benefit in refractory MAC disease. Clinical decision-making must balance efficacy, tolerability, and long-term adherence, highlighting the need for individualized treatment strategies and regular monitoring. This review outlines current evidence and practical recommendations for clinicians managing NTM-PD.

Human genetics is increasingly becoming an important tool to supplement conventional clinical and laboratory diagnostics and is playing an increasingly important role in clinical medicine. Genetics can help to avoid further, sometimes invasive, examinations and provide important information to confirm, specify, or correct a suspected clinical diagnosis.

PD, often underestimated, is more than a dialysis method - it is a promise of autonomy and quality of life. Especially in times of demographic shifts, rising chronic conditions, and healthcare staff shortages, PD is gaining relevance as an equal alternative to hemodialysis (HD). While HD dominates dialysis care in Germany (94%), international comparisons show a far more balanced use of modalities.PD utilizes the peritoneum as a natural dialysis membrane and can be performed manually (CAPD) or automatically at night (APD). With proper training, even elderly or dependent patients can safely manage PD at home or with support, enabling greater flexibility and reducing strain on healthcare infrastructure.General practitioners play a key role in early identification and education of chronic kidney disease (CKD) patients, offering PD as an empowering treatment path. Structured training and close monitoring help prevent complications such as peritonitis or peritoneal sclerosis.Remarkably, 55% of nephrologists would choose PD for themselves, compared to only 9% who would opt for the most commonly used method - center-based HD.PD is not a second-choice option. It is a viable, gentle, and forward-looking renal replacement therapy - an answer to the demographic and resource challenges ahead. Sometimes, modern nephrology begins not in a clinic, but quietly at the kitchen table.

Nephropathology is a subdiscipline of pathology requiring specialized knowledge and technical equipment, and is therefore not offered by all pathology institutes. Specialized histopathological examinations of kidney biopsies began with the first percutaneous kidney biopsy in 1958, replacing urine analysis as the main diagnostic tool for kidney disease, which had been common since the Middle Ages. Nowadays, radiologists can also perform a transvenous biopsy when contraindications for a percutaneous biopsy are present. Special techniques are required to assess kidney biopsies, such as special staining, immunofluorescence, immunohistology and, in particular, electron microscopy. The ultrastructural examination of kidney biopsies is one of the few remaining routine applications of electron microscopy in pathology today.The following section will present and discuss the essential technical and methodological requirements for the detailed processing and diagnosis of kidney biopsies, as well as current developments in the field.