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Books: 234	Journals: 18	Articles: 21295

Abstract

Nieren- und Hochdruckkrankheiten, Jahrgang 55, Nr. 4/2026, S. 202

Moderne Therapien eröffnen neue Chancen: Nierenscreening heute wichtiger denn je – chronische Nierenkrankheit früh erkennen und Dialyse vermeiden

Abstract

Verdauungskrankheiten, Jahrgang 44, Nr. 2/2026, S. 53-54

Editorial

E. Endlicher und H. Messmann

Abstract

Verdauungskrankheiten, Jahrgang 44, Nr. 2/2026, S. 55-64

Epidemiologie des Barrett-Ösophagus: Aktuelle Daten zu Häufigkeit, Risikofaktoren und Folgen

J. Reizner und J. Linseisen

Institut für Epidemiologie, Medizinische Fakultät der Universität Augsburg, Augsburg
Der Barrett-Ösophagus (BE) stellt eine prämaligne Metaplasie des distalen Ösophagus dar und ist – abhängig vom Dysplasiegrad – mit einem stark erhöhten Risiko für die Entwicklung eines Adenokarzinoms der Speiseröhre (EAC) verbunden. Diese Übersicht stellt die aktuelle epidemiologische Evidenz zur Verbreitung von BE in der Bevölkerung zusammen und beleuchtet die zentralen Risikofaktoren. Aktuelle Studien weisen eine BE-Prävalenz von 2,2 – 4,9% in der Allgemeinbevölkerung ohne Symptome aus, bei Personen mit Symptomen der gastroösophagealen Refluxkrankheit (GERD) war die Prävalenz von BE mit 7,0 – 7,7% deutlich höher. 15% der BE-Patienten weisen eine Dysplasie auf (davon 81% eine geringgradige Dysplasie). Der Anteil der BE-Fälle mit Diagnosestellung vor dem 50. Lebensjahr liegt bei etwa 15 – 20%, mit steigender Tendenz. Als etablierte Einflussgrößen gelten, neben GERD, männliches Geschlecht, höheres Lebensalter, viszerale Adipositas, Nikotinkonsum sowie eine positive Familienanamnese. BE ist die einzige bekannte Vorläuferläsion für die Entwicklung eines EAC, sodass der Früherkennung und Verlaufsbeobachtung von BE eine herausragende Rolle in der EAC-Prävention zukommen.Correspondence to:
Julia Reizner, MSc
Institut für Epidemiologie
Universitätsklinikum Augsburg
Stenglinstraße 2
86156 Augsburg
Email: [email protected]

Abstract

Verdauungskrankheiten, Jahrgang 44, Nr. 2/2026, S. 65-70

Histopathologische Diagnostik des Barrett- Ösophagus

A. Tannapfel und S. Förster

Institut für Pathologie der Ruhr-Universität Bochum
Der Barrett-Ösophagus ist eine Metaplasie der distalen Ösophagusschleimhaut, die ein erhöhtes Risiko für die Entstehung einer Dysplasie und somit eines Adenokarzinoms birgt. Zwar weiß man heute, dass dieses Risiko wesentlich geringer ist als ursprünglich angenommen, dennoch hat die Diagnose eines Barrett-Ösophagus weitreichende Konsequenzen. Molekulare Alterationen, die schließlich zur Entstehung eines invasiven Karzinoms führen, können zum Teil schon im Barrett-Ösophagus selbst gefunden werden. Sie helfen in der täglichen Diagnostik jedoch nur bedingt. Die Diagnose der Dysplasie ist mitunter schwierig, insbesondere bei unklaren Fällen sollte ein erfahrener gastroenterologisch versierter Pathologe hinzugezogen werden. Die Befundung invasiver Karzinome ist richtungsweisend und muss festgelegte Standards einhalten.Correspondence to:
Dr. med. Sarah Förster
Institut für Pathologie der Ruhr-Universität Bochum
am BG Universitätsklinikum Bergmannsheil
Bürkle-de-la-Camp-Platz 1
44789 Bochum
Email: [email protected]

Abstract

Verdauungskrankheiten, Jahrgang 44, Nr. 2/2026, S. 71-80

Prädiktive Risikofaktoren und Screening des Barrett-Ösophagus – Ansätze zur medikamentösen Prävention

D. Roser

III. Medizinische Klinik m.S. Gastroenterologie, Universitätsklinikum Augsburg
Die Inzidenz des Adenokarzinoms der Speiseröhre (EAC) steigt in der westlichen Welt seit Jahrzehnten rasant an. Gleichzeitig liegt die 5-Jahres-Überlebensrate von Patienten mit einem EAC in Deutschland bei unter 26% – eine der schlechtesten Prognosen unter allen Krebsarten. Der Barrett-Ösophagus spielt als einzige bekannte Präkanzerose eine zentrale Rolle und erhöht das Risiko, ein EAC zu entwickeln, um das 30- bis 125-Fache. Die frühzeitige Erkennung neoplastischer Veränderungen und das korrekte Management von Risikopatient/-innen sind daher essenzielle Bausteine der Präventivmedizin. Der folgende Beitrag beleuchtet differenziert prädiktive Risikofaktoren für die Entwicklung eines EAC sowie neue Erkenntnisse zur Risikostratifizierung und Diagnostik. Eine individualisierte Herangehensweise mit Fokus auf prädiktive Faktoren, selektives Screening und gezielte Chemoprophylaxe bietet Potenzial zur Reduktion von Inzidenz und Mortalität.Correspondence to:
Dr. David A. Roser
III. Medizinische Klinik
Universitätsklinikum Augsburg
Stenglinstraße 2
86156 Augsburg
Email: [email protected]

Abstract

Verdauungskrankheiten, Jahrgang 44, Nr. 2/2026, S. 81-88

Barrett-Ösophagus – Endoskopische Diagnostik

M.W. Scheppach¹ und A. Ebigbo²

¹III. Medizinische Klinik – Gastroenterologie, Universitätsklinikum Augsburg, Augsburg, ²Medizinische Klinik I – Universitätsklinikum St. Josef-Hospital, Bochum
Der Barrett-Ösophagus stellt mit einer Prävalenz von 1 – 2% in der Allgemeinbevölkerung die wichtigste Präkanzerose des ösophagealen Adenokarzinoms dar. Die endoskopische Diagnostik bildet das Fundament der Erkennung, Klassifikation und Überwachung. Neben der standardmäßig eingesetzten hochauflösenden Weißlichtendoskopie sollten bildverstärkende Methoden wie digitale Chromoendoskopie (zum Beispiel Narrow Band Imaging, Blue Light Imaging und i-scan) und Essigsäurefärbung eingesetzt werden, um dysplastische Veränderungen besser zu detektieren. Die Essigsäurefärbung erhöht die Sensitivität durch das charakteristische „de-whitening sign“ dysplastischer Areale. Verdächtige Läsionen werden nach der Paris-Klassifikation und der Klassifikation durch die Barrett‘s International Narrow Band Imaging Group (BING) eingeteilt. Die Endosonographie weist bei frühen Läsionen methodische Schwächen auf und wird vor endoskopischer Resektion früher Neoplasien nicht routinemäßig empfohlen. Das diagnostische Vorgehen erfolgt nach festgelegten Algorithmen mit gezielten Biopsien suspekter Areale und ungezielten Quadrantenbiopsien nach dem Seattle-Protokoll. Die Überwachungsintervalle orientieren sich am histologischen Grading mit Intervallen von 3 – 5 Jahren bei nicht dysplastischem Barrett bis zu vierteljährlichen Kontrollen nach endoskopischer Resektion von pT1-Karzinomen. Die künstliche Intelligenz zeigt vielversprechende Ansätze zur automatisierten Neoplasiedetektion. Die multimodale endoskopische Diagnostik ermöglicht eine präzise Risikostratifizierung und stadiengerechte Therapieplanung beim Barrett-Ösophagus.Correspondence to:
Markus W. Scheppach
3. Medizinische Klinik – Gastroenterologie
Universitätsklinikum Augsburg
Stenglinstrasse 2
86156 Augsburg
Email: [email protected]

Abstract

Verdauungskrankheiten, Jahrgang 44, Nr. 2/2026, S. 89-95

Resektion von Barrettfrühneoplasien: wann EMR, wann ESD?

A. Probst

Universitätsklinikum Augsburg, III. Medizinische Klinik, Augsburg
Die endoskopische Resektion (ER) stellt für Barrett-assoziierte Frühneoplasien die Therapie der Wahl dar. Histopathologische Parameter (Eindringtiefe, Differenzierung, Lymphgefäßinvasion) sind für das Erreichen einer kurativen Resektion zu berücksichtigen. Zur ER stehen die endoskopische Mukosaresektion (EMR) und die endoskopische Submukosadissektion (ESD) zur Verfügung. In Meta-Analysen konnte eine Überlegenheit der ESD hinsichtlich en bloc-Resektionsrate, R0-Resektionsrate und Lokalrezidivrate bei vergleichbarer Komplikationsrate gezeigt werden. In nationalen und internationalen Leitlinien liegen unterschiedliche Empfehlungen zum Einsatz beider Verfahren vor. Bei morphologischem Verdacht oder bioptisch gesichertem Barrettfrühkarzinom sollte eine R0-Resektion unbedingt angestrebt werden. Da die ESD hierzu die höchste Erfolgsrate garantiert, sollte die ESD gegenüber der EMR favorisiert werden. Die EMR sollte auf kleine, flache Läsionen beschränkt bleiben.Correspondence to:
Dr. Andreas Probst
Universitätsklinikum Augsburg
III. Medizinische Klinik
Stenglinstrasse 2
86156 Augsburg
Email: [email protected]

Abstract

Verdauungskrankheiten, Jahrgang 44, Nr. 2/2026, S. 96-108

Barrettösophagus und assoziierte Neoplasien: Stellenwert einer endoskopischen Ablationstherapie

T. Dertmann und T. Beyna

Evangelisches Krankenhaus Düsseldorf, Medizinische Klinik, Düsseldorf
Die endoskopische Ablationstherapie beim Barrettösophagus reduziert effektiv das Risiko für eine Progression zu hochgradiger Dysplasie und Adenokarzinomen, sollte jedoch risikoadaptiert eingesetzt werden. Während beim nicht-dysplastischen Barrettösophagus aufgrund des insgesamt geringen Risikos für eine Progression in der Regel keine Ablation indiziert ist, sollten Dysplasien nach referenzpathologischer Bestätigung im Falle einer sichtbaren Läsion vollständig reseziert, andernfalls abladiert werden. Hierbei ist die Radiofrequenzablation das bestuntersuchte Verfahren, während die Hybrid-APC und Kryoablation vielversprechende Alternativen darstellen. Therapieentscheidungen sollten individuell unter Berücksichtigung von Patientenfaktoren erfolgen.Correspondence to:
OA Tobias Dertmann
Evangelisches Krankenhaus Düsseldorf
Medizinische Klinik
Kirchfeldstraße 40
40217 Düsseldorf
Email: [email protected]

Abstract

Verdauungskrankheiten, Jahrgang 44, Nr. 2/2026, S. 109-113

Überwachung des Barrettösophagus

S. Baumer und O. Pech

Klinik für Gastroenterologie und interventionelle Endoskopie, Krankenhaus Barmherzige Brüder, Regensburg
Bei Patienten mit einem Barrett-Ösophagus empfehlen alle Leitlinien regelmäßige Überwachungsendoskopien. Ob ein solches Überwachungsprogramm Barrett-Neoplasien in einem früheren Stadium detektiert und damit das Überleben dieser Patienten positiv beeinflusst wird, ist zunehmend umstritten. Die Ergebnisse aus dem BOSS-Trial sprechen gegen die Effektivität einer regelmäßigen Überwachung. Zukünftig werden wahrscheinlich Biomarker zur Verfügung stehen, die eine Risikostratifizierung zulassen, so dass nur noch Patienten mit hohem Risiko für das Entstehen einer Neoplasie regelmäßig überwacht werden. Dann ist es auch eher wahrscheinlich, dass ein solches Überwachungsprogramm kosteneffektiv ist. Bis dahin gelten aber weiterhin die in den Leitlinien empfohlenen regelmäßigen endoskopischen Untersuchungen mit empfohlenen Überwachungsintervallen.Correspondence to:
Prof. Dr. Oliver Pech
und
Dr. Sebastian Baumer
Klinik für Gastroenterologie und interventionelle Endoskopie
Krankenhaus Barmherzige Brüder
Prüfeninger Straße 86
93049 Regensburg
Email: [email protected]; [email protected]

Abstract

Verdauungskrankheiten, Jahrgang 44, Nr. 2/2026, S. 114-120

Welche Barrett-Neoplasien müssen operiert werden und wie?

K. Beyer

Klinik für Allgemein-, Viszeral-, Transplantations- und Thoraxchirurgie, Allgemein- und Viszeralchirurgie, Universität Augsburg, Augsburg
Während die operative Therapie von Barrett-Neoplasien ein wichtiger Bestandteil multimodaler Konzepte in lokal fortgeschrittenen Stadien ist, tritt sie bei Frühkarzinomen durch die Optimierung endoskopischer Resektionstechniken zunehmend in den Hintergrund. Die Kombination aus endoskopischer Resektion und Ablation des verbleibenden Barretts ermöglicht hier in vielen Fällen den Organerhalt. Ein entscheidender Faktor für oder gegen die chirurgische Therapie ist im Falle von Frühneoplasien die Wahrscheinlichkeit von Lymphknotenmetastasen im individuellen Fall, da diese im prätherapeutischen Staging nur äußerst eingeschränkt erfasst werden können. Sentinel-Lymphknotenkonzepte sind aktuell für das Barrett-Karzinom nicht etabliert. Operatives Standardvorgehen ist bei lokal fortgeschrittenen Stadien die abdominothorakale Ösophagusresektion mit 2-Feld-Lymphadenektomie und Hochzug eines Magenschlauchs im Rahmen eines multimodalen Therapiekonzepts. Diese Operation kann in Zentren mit sehr niedriger Mortalität und langfristig einer guten Lebensqualität durchgeführt werden. Der Stellenwert der prophylaktischen Ausräumung der Lymphknoten der oberen Thoraxapertur wird aktuell kontrovers diskutiert. Der Mehrwert minimal-invasiver Verfahren bei der Ösophagusresektion ist evidenzbasiert. Für einen weiteren Vorteil robotischer Verfahren gibt es erste Hinweise. Die starke Durchdringung der robotischen Ösophagusresektion weltweit lässt antizipieren, dass dies künftig das Standardverfahren sein wird. Ist die Bildung eines Magenschlauchs durch Voroperationen oder aus onkologischen Gründen nicht möglich, weil keine Tumorfreiheit nach aboral erreicht werden kann, ist die Interposition von Kolon ein etabliertes Verfahren, mit dem ebenfalls eine gute Lebensqualität erreicht werden kann. Sind T1-Karzinome endoskopisch nicht resektabel, besteht die Möglichkeit einer limitierten Resektion vom proximalen Magen und distalem Ösophagus. Ob dies das funktionelle Outcome signifikant verbessert, kann aktuell nicht abschließend beurteilt werden.Correspondence to:
Prof. Dr. med. Katharina Beyer
Klinik für Allgemein-, Viszeral-, Traansplantations- und Thoraxchirurgie
Universitätsklinikum Augsburg
Universität Augsburg
Stenglinstraße 2
86156 Augsburg
Email: [email protected]

Abstract

Clinical Neuropathology, Vol. 45 – No. 2/2026 – Letter to the editor

Glioblastoma, IDH-wildtype with melanocytic differentiation: An exceedingly rare morphology and immunophenotype

Simone Poidomani, Serena Salzano, Gaetano Magro, and Giuseppe Broggi

Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia” Anatomic Pathology, University of Catania, Catania, Italy
Correspondence to:
Giuseppe Broggi, MD, PhD
Department of Medical and Surgical Sciences and
Advanced Technologies “G.F. Ingrassia”
Anatomic Pathology, University of Catania
95123 Catania, Italy
Email: [email protected]

Abstract

Clinical Neuropathology, Vol. 45 – No. 2/2026 (66-75)

Evidence of blood-brain barrier disruption in pathologic stage IV chronic traumatic encephalopathy without dementia

Jeff Henderson¹, Adam McGlinchey¹, Bríd Murphy², Aoife Canney³, Matthew Campbell¹#⁴*, and Michael Farrell⁵*

¹Smurfit Institute of Genetics, School of Genetics and Microbiology, ²Department of Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin, ³Department of Pathology, University Hospital, Galway, ⁴FutureNeuro Research Ireland Centre, Smurfit Institute of Genetics, School of Genetics and Microbiology, Trinity College Dublin, and ⁵Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
Repetitive head injury in athletes has been increasingly linked to the development of chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disorder. However, its underlying pathobiology remains poorly understood, and definitive diagnosis requires post-mortem examination due to the absence of established in-life biomarkers. Here, we report the neuropathological findings in a retired elite rugby union player with a prolonged history of repetitive head impacts and progressive behavioral changes in the decade preceding his death at the age of 60. The clinical course was characterized by gradually progressive behavioral and affective disturbance in the absence of overt cognitive impairment. Neuropathological findings were consistent with stage IV CTE, with phosphorylated tau (p-Tau) deposition involving neocortical, hippocampal, and midbrain regions, and exhibiting a characteristic distribution in the sulcal depths and perivascular zones. No β-amyloid, α-synuclein, or TDP-43 pathology was identified, suggesting the absence of coexistent neurodegenerative tauopathies. Analysis of blood-brain barrier (BBB) integrity demonstrated reduced claudin-5 immunoreactivity and diffuse immunoglobulin G extravasation in the sulcal depths, overlapping with dense p-Tau deposition, suggestive of BBB dysfunction. To our knowledge, this is the first description of BBB alterations in a case of CTE without dementia or evidence of a coexisting neurodegenerative disease. While based on a single case, warranting cautious interpretation, these findings add to accumulating evidence suggesting that BBB alteration may represent a hallmark feature of CTE.

*These authors contributed equally to this workCorrespondence to:
Prof. Matthew Campbell
Smurfit Institute of Genetics
School of Genetics and Microbiology
Trinity College Dublin
Dublin 2, DO9 V2NO Ireland
or
Dr. Michael Farrell
Department of Neuropathology
Beaumont Hospital
Dublin, DO9 V2NO Ireland
Email: [email protected]; [email protected]

Abstract

Clinical Neuropathology, Vol. 45 – No. 2/2026 (56-65)

Bifocal cerebellar liponeurocytoma with atypical features: A case report and a literature review

Maysa Al-Hussaini¹, Sarah Al Sharie², Saif Azzam³, Madiha Erashdi⁴, Asem Mansour⁵, and Mouness Obeidat⁶

¹Department of Cell Therapy and Applied Genomics (CTAG), King Hussein Cancer Center, Amman, Jordan, ²Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA, ³Faculty of Medicine, Yarmouk University, Irbid, Jordan, ⁴Department of Pathology, James Cook University Hospital, South Tees National Health Service (NHS) Foundation Trust, Middlesbrough, United Kingdom, ⁵Department of Radiology, and ⁶Department of Surgery, Unit of Neurosurgery, King Hussein Cancer Center, Amman, Jordan
Cerebellar liponeurocytoma (cLNC) is a rare tumor. It affects adults with no sex predilection. It appears as a heterogeneously enhancing mass, most commonly unifocal. Histologically, it is a biphasic neurocytic tumor with lipomatous component, with minimal atypia, and low proliferative index, corresponding to central nervous system (CNS) World Health Organization (WHO) grade 2. TP53 missense mutation is reported in 20% of cases. Gross total resection, with or without radiotherapy, is considered an adequate treatment. Bifocality and features of anaplasia are rarely reported. We are reporting a 41-year-old lady with bilateral cerebellar contrast-enhancing masses who underwent gross total resection 3 months apart. Pathology revealed features consistent with cLNC. However, the tumor resected from the right cerebellar hemisphere demonstrated atypical morphological features, including microvascular proliferation and necrosis. Ki-67 proliferative marker was estimated at 10% in the most active areas. Next-generation sequencing (NGS) revealed 2 pathogenic mutations within exonic regions of ERBB2, and PIK3CA genes, and a variant mutation of unknown significance (VUS) involving the PDGFRA gene. DNA methylation profiling confirmed the diagnosis of cLNC. The patient has been under observation without any further intervention for 70 months since diagnosis, with no evidence of disease recurrence. In addition to the rarity of cLNC, this is a unique case in terms of bifocality, anaplastic histology, and the described genetic abnormalities.Correspondence to:
Maysa Al-Hussaini, MD, FRCPath
Department of Cell Therapy and Applied Genomics
King Hussein Cancer Center
202 Queen Rania Al-Abdullah Street
P.O. Box 1269
Al-Jubaiha, Amman 11941 Jordan
Email: [email protected]

Abstract

Clinical Nephrology, Vol. 106 – No. 1/2026 (67-75)

From shelter to stroke: A mediation-proxy analysis of homelessness-associated stroke risk in dialysis patients 

Sanat Subhash¹*, Haziq Rabbani¹*, Nanak Dhillon¹, Noah Glass¹, Flora Gallegos¹, Shyam Bihari Bansal², Prakash Gudsoorkar³, and Rupesh Raina¹

¹Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA, ²Department of Nephrology, Medanta-Medicity, Gurgaon, India, and ³Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
Background: Dialysis patients face high ischemic stroke risk, only partly explained by cardiometabolic and genetic factors. Homelessness, race, and other social determinants may further elevate risk, but the pathways affecting outcomes in dialysis patients remain uncharacterized.
Materials and methods: We conducted a retrospective cohort study using the TriNetX electronic health record network, identifying 8,821 adults with at least one homelessness code and 320,432 housed adults who initiated dialysis between 2014 – 2024 with ≥ 5 years of prior data. The primary outcome was time to first ischemic stroke within 5 years. A multivariable Cox model adjusted for age, sex, race/ethnicity, and dialysis modality estimated the total homelessness effect (HR₀). We then ran 3 hazard‐attenuation models, each adding 1 composite mediator block, clinical (hypertension, diabetes, hyperlipidemia, obesity), psychosocial (nicotine dependence, depression), and social-adversity (ICD-10 Z56–Z65 codes), to calculate the percent reduction in the homelessness log‐hazard. Sensitivity analyses used a composite stroke‐or‐death endpoint and a landmark survivor cohort excluding early deaths.
Results: Homelessness conferred a 4.61‐fold higher 5‐year stroke hazard. The clinical block attenuated this hazard by 12.1%, and the psychosocial block by 15.2%. In contrast, the social-adversity block amplified the effect by 27.4%, reflecting a suppressor phenomenon from under-documented social determinants of health codes. Sensitivity checks confirmed robustness, with a stroke‐or‐death HR 1.35 and death‐free cohort HR 4.50.
Conclusion: Pre-dialysis homelessness and Black race independently predict stroke risk in dialysis patients. This reaffirms the need for standardized social‐needs screening, area‐level deprivation measures, and advanced data‐extraction methods to accurately capture social adversity and guide targeted interventions.

*Both are first coauthor.Correspondence to:
Rupesh Raina, MD, FAAP, FACP, FASN, FNKF, Consultant Nephrologist
Adult-Pediatric Kidney Disease/Hypertension
Department of Nephrology
Cleveland Clinic Akron General and Akron Children’s Hospital
214 West Bowery Street
Akron, Ohio 44308, USA
Email: [email protected]

Abstract

Clinical Nephrology, Vol. 106 – No. 1/2026 (27-34)

Simplified nutritional and inflammatory indicators for long-term survival from all-cause mortality in maintenance hemodialysis 

Qiaoming Jiang¹, Jiangkai Yu², Yutao Zhao¹, and Yingchun Xiao³

¹Department of Hemopurification Center, Jiangsu Taizhou People’s Hospital Affiliated to Nanjing Medical University, Taizhou City, Jiangsu Province, ²Department of Clinical Medicine, Southeast University School of Medicine, Nanjing City, and ³Department of Nephrology, Jiangsu Taizhou People’s Hospital Affiliated to Nanjing Medical University, Taizhou City, Jiangsu Province, China
Objective: To investigate superior prognostic accuracy for long-term survival from all-cause mortality in patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis (MHD).
Materials and methods: Reviews of 2,859 ESRD patients on MHD were retrieved. The Geriatric Nutritional Risk Index (GNRI) and systemic immune inflammation index (SII) was utilized to develop a composite score of nutritional-systemic immune inflammation (N-SII). Primary endpoint was prognostic capability for long-term survival from all-cause mortality including cardiovascular events, cerebrovascular events, and infection episodes through an area under curve (AUC) using receiver operating characteristic analysis. Secondary outcomes included optimal cut-off value and hazard ratio.
Results: The composite scoring system of N-SII had a better prognostic accuracy for long-term survival from all-cause mortality in hemodialysis patients with a greater AUC of 0.850 (95% CI: 0.825 – 0.874) compared to either the isolated score of GNRI or SII (AUC = 0.761 (95% CI: 0.725 – 0.791) and 0.782 (95% CI: 0.767 – 0.826)) (p < 0.001). Superiority was met if the 95% CI fell within a superiority margin of 0.80. High-risk N-SII score was an independent predictor for all-cause mortality (HR = 2.049 (95% CI: 1.668 – 2.516)) with specificity and sensitivity of 0.784 and 0.899. A significantly shorter survival from all-cause death was observed in high-risk N-SII cohort as opposed to low-risk (44.14 (95% CI: 42.76 – 45.52) vs. 31.19 (95% CI: 28.50 – 33.89), p < 0.001).
Conclusion: The composite index of N-SII showed a superior prognostic accuracy for long-term survival from all-cause mortality as opposed to isolated GNRI or SII, highlighting the integration of nutritional and inflammatory indexes for effective risk stratification of prognostic assessment among patients on MHD.Correspondence to:
Yingchun Xiao, PhD
Department of Hemopurification Center
Jiangsu Taizhou People’s Hospital
Affiliated to Nanjing Medical University
No. 366 Taihu Street, Medical High-tech Zone
Taizhou City, Jiangsu Province, 225300, China
Email: [email protected]

Abstract

Clinical Nephrology, Vol. 106 – No. 1/2026 (35-46)

Clinical perspective on renal artery stenosis: A single-center experience 

Simal Koksal Cevher¹, Ender Ornek², Ezgi Coskun Yenıgun¹, Duygu Guzel Ozkan³, Emre Cankaya¹, Meryem Keles¹, Muge Uzerk Kıbar¹, and Fatih Dede¹

¹Department of Nephrology, ²Department of Cardiology, Ankara Bilkent City Hospital, Ankara, and ³Department of Internal Medicine, Haydarpasa Numune Training and Research Hospital, Istanbul, Türkiye
Objective: The aim of this paper is to evaluate the effectiveness of percutaneous angiographic stenting in carefully selected, symptomatic patients diagnosed with hemodynamically significant atherosclerotic renal artery stenosis (ARAS) followed in our clinic.
Materials and methods: This retrospective study included 69 patients who underwent renal artery stenting due to renal artery stenosis between 2011 and 2023 in our clinic. Demographic, clinical, and laboratory data were retrospectively retrieved from the hospital’s electronic health records. Duplex ultrasonography (DU) was used as the primary screening tool; however, the decision to stent was made only after confirmatory catheter angiography demonstrated ≥ 60% stenosis with an anatomically treatable lesion in a clinically high-risk context (resistant hypertension, acute kidney injury/acute-on-chronic kidney disease, or flash pulmonary edema). Laboratory parameters, blood pressure levels, and antihypertensive medication requirements were compared at baseline and 1 month following the procedure.
Results: Over the 12-year study period, 69 patients underwent renal artery stenting involving a total of 86 renal arteries. Of these patients, 31 (44.9%) were female, and the mean age was 65.75 years (SD = 10.75; range = 41 – 87 years). Conventional angiography was performed in 51 patients (73.9%), while carbon dioxide angiography was utilized in 18 patients (26.1%). All 69 patients underwent simultaneous stent placement during angiography. One month post procedure, urea and creatinine levels decreased in these patients; notably, among 20 patients who presented with acute kidney injury, creatinine levels returned to normal in 11 patients (55%) at 1-month follow-up. Additionally, in 6 out of 12 patients (50%) with acute exacerbations of chronic kidney disease, creatinine levels reverted to baseline. Pulmonary edema, observed in 16 patients (23.2%) at presentation, resolved completely in all affected patients 1 month after the intervention. The reduction rates in systolic blood pressure (SBP) and diastolic blood pressure (DBP) 1 month post procedure were 23.28 ± 11.67% and 20.48 ± 12.49%, respectively, both statistically significant (for SBP: p = 7 × 10^–13, effect size r = 0.868, matched-pairs rank-biserial correlation r_rb = –1; for DBP: p = 5.4 × 10^–12, effect size r = 0.869, matched-pairs rank-biserial correlation r_rb = –1). The mean number of antihypertensive medications significantly decreased from baseline to 1 month after renal artery stenting (mean ± SD: 3.36 ± 1.37 vs. 2.10 ± 1.12; Wilcoxon signed-rank test, V = 1.693, p < 0.001, effect size r = 0.85 > 0.50).
Conclusion: Intervention with stent placement in symptomatic/high-risk ARAS patients presenting with resistant hypertension, acute kidney injury, or flash pulmonary edema associated with significant renal artery stenosis can result in clinical improvement and a reduction in antihypertensive medication requirements, even within a short follow-up period of 4 weeks. Given the retrospective design, lack of a control group, and short follow-up, these findings should be interpreted as association rather than causation and cannot address long-term outcomes (e.g., restenosis, durable renal preservation, or cardiovascular events).Correspondence to:
Simal Koksal Cevher, MD
Ankara Bilkent City Hospital
Department of Nephrology
Universiteler Mah. Bilkent Cad. No: 1
Cankaya/Ankara, Turkey
Email: [email protected]

Abstract

Allergologie select, Vol. 10/2026 (49-51)

A case of herpes zoster following the first dose of benralizumab

Kurtuluş Aksu, Onur Telli, Melis Yağdıran, Fatma Dindar Çelik, Hatice Çelik Tuğlu, and Özge Göktürk

Division of Immunology and Allergy, Department of Chest Diseases, Ankara Atatürk Sanatoryum Training and Research Hospital, University of Health Sciences, Ankara, Turkiye
Introduction: Biological agents used in the treatment of rheumatic diseases and malignancies cause an increase in herpes zoster susceptibility. This may also be the case for monoclonal antibody treatments used in asthma based on recent pharmacovigilance data. Case report: Herpetic lesions occurred on the anterior chest wall of a 43-year-old patient who was initiated on benralizumab treatment for severe eosinophilic asthma. The patient received diagnosis of herpes zoster and showed significant clinical improvement with oral valacyclovir treatment. Since it was not certain whether the herpes eruption was directly related to benralizumab treatment, benralizumab treatment was continued at the patient’s request and with the approval of the dermatology department. The patient did not experience recurrent herpes eruptions or any other clinical problems with the repeated doses given.Correspondence to:
Prof. Kurtuluş Aksu, MD, Professor in Allergy and Pulmonology, Ankara Atatürk Sanatoryum Eğitim ve Araştırma Hastanesi, 06280, Keçiören, Ankara, Türkiye
Email: [email protected]

Abstract

Clinical Nephrology, Vol. 106 – No. 2/2026 (110-118)

Evaluation of epicardial adipose tissue in children with chronic kidney disease 

Mehmet Baha Aytac¹, Mustafa Dogan², Sule Ayas Ergul¹, Mahmud Cirakoglu², Kenan Dogan¹, Evic Zeynep Akgun², Neslihan Dincer Malkoc¹, Kadir Babaoglu², and Kenan Bek¹

¹Department of Pediatric Nephrology and ²Department of Pediatric Cardiology, Faculty of Medicine, Kocaeli University, Izmit, Turkiye
Aims: Previous studies in adults have demonstrated that epicardial adipose tissue could be used to predict the risk of the development of cardiovascular disease in patients with diabetes mellitus, obesity, and chronic kidney disease. Herein, we aimed to evaluate epicardial adipose tissue, carotid intima-media thickness and left ventricular mass index in children with chronic kidney disease and compare the results with healthy subjects.
Materials and methods: 23 children who were diagnosed with chronic kidney disease or received kidney replacement therapy constituted the patient group; 21 age- and sex-matched healthy subjects served as the control group. Epicardial adipose tissue, carotid intima-media thickness, and left ventricular mass index obtained by using transthoracic echocardiography, demographic and biochemical parameters were compared.
Results: No significant difference was detected between patients and healthy controls in terms of age, weight, height, body mass index, systolic and diastolic blood pressures. Serum glucose, calcium, phosphorus, and lipid levels were also similar. Although echocardiographic examination revealed lower epicardial adipose tissue thickness and higher mass index in patients with chronic kidney disease compared to healthy subjects (6.45 ± 1.61 vs. 7.70 ± 1.69 mm, p < 0.05), no difference was observed in carotid intima-media thickness measurement (0.40 (0.37 – 0.44) vs. 0.42 (0.35 – 0.50) mm, p = 0.29).
Conclusion: Larger and long-term studies in children are needed to use epicardial adipose tissue thickness as an effective method to estimate the development of cardiovascular disease in patients with chronic kidney disease.Correspondence to:
Mehmet Baha Aytac, MD
Department of Pediatric Nephrology
Faculty of Medicine
Kocaeli University
41001 Umuttepe Izmit, Kocaeli, Turkiye
Email: [email protected]

Abstract

Clinical Nephrology, Vol. 106 – No. 1/2026 (47-57)

Impact of different A1c targets on cardiovascular outcomes in diabetic kidney transplant recipients: A global cohort analysis 

Sindhura Bobba¹, Gaurav Gupta², Dhiren Kumar², Amber B. Paulus², Akshay Athreya², Rushi Patel², and Nilang G. Patel¹

¹Richmond VA Medical Center, and ²Virginia Commonwealth University, Richmond, VA, USA
Background: Optimal glycemic targets for diabetic kidney transplant recipients (KTRs) remain uncertain, particularly regarding cardiovascular outcomes.
Materials and methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network, including adult KTRs with type 2 diabetes transplanted from 2010 – 2021. Patients with simultaneous kidney-pancreas or pancreas-alone transplants were excluded. HbA1c measured 1 – 2 years post transplant was categorized as ≤ 7.5% or > 7.5%. Propensity score matching (1 : 1) balanced demographics, comorbidities, laboratory values, immunosuppression, and medications. The primary outcome was major adverse cardiovascular events (MACE: myocardial infarction, stroke, heart failure, cardiac arrest, or death); secondary outcomes included individual components of MACE and graft failure.
Results: The final matched cohort included 5,850 patients (2,925 per group). Over median follow-up of 4.2 years, MACE occurred in 33.4% of patients with HbA1c ≤ 7.5 vs. 39.1% with > 7.5% (adjusted hazard ratio (aHR) 0.88, 95% CI 0.78 – 0.98). Mortality was lower in the ≤ 7.5% group (19.6 vs. 23.7%; aHR 0.85, 95% CI 0.76 – 0.95). No significant differences were observed in graft failure, myocardial infarction, heart failure, or stroke. Sensitivity analyses demonstrated lowest MACE and mortality risk at HbA1c 7.0 – 8.0%, with attenuation at ≤ 7.0% and loss of significance at ≤ 6.5%. Cardiovascular benefit was most pronounced in patients < 65 years and those with favorable lipid profiles.
Conclusion: In this global retrospective observational study, moderate glycemic control (HbA1c ~ 7 – 8% measured 1 – 2 years post transplant) was associated with lower cardiovascular events and mortality in type 2 diabetic KTRs. These findings support individualized targets aimed at avoiding both poor control and overly intensive lowering.Correspondence to:
Gaurav Gupta, MD
Virginia Commonwealth University
1200 E Marshall St, PO Box 980160
Richmond, VA, USA
Email: [email protected]

Abstract

Clinical Nephrology, Vol. 106 – No. 1/2026 (58-66)

Association of recipient age with deceased donor kidney transplant outcomes in a single-center cohort 

Paul E. Schindler¹, Dave B. Patel¹, Camille R. Ylagan¹, Adam P. Bregman¹, Didier Mandelbrot¹, Brad C. Astor¹#², and Sandesh Parajuli¹

¹Division of Nephrology, Department of Medicine, and ²Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
Introduction: As the number of elderly patients with end-stage kidney disease (ESKD) increases, the importance of understanding how age affects post-transplant success grows. We sought to quantify the association of age with key outcomes in deceased donor kidney transplant (DDKT) recipients.
Materials and methods: We did a single-center retrospective cohort analysis of all DDKT recipients who received kidneys between January 2001 and June 2021, stratified by age into 4 groups (18 – 49, 50 – 59, 60 – 69, ≥ 70). Outcomes of interest included uncensored graft failure (UCGF), death-censored graft failure (DCGF), and death with a functioning graft (DWFG) within 5 years of transplant and acute rejection (AR) within 1 year of transplant.
Results: Of 3,119 recipients, 1,192 (38.2%) were 18 – 49 years old (reference group), 947 (30.4%) were 50 – 59, 795 (25.5%) were 60 – 69, and 185 (5.9%) were ≥ 70. The adjusted hazard ratio (aHR) for UCGF was 1.22 (95% CI: 1.01 – 1.48) for 50 – 59 years; 1.78 (95% CI: 1.47 – 2.17) for 60 – 69; and 2.83 (95% CI: 2.13 – 3.76) for ≥ 70. The aHR for DCGF was only statistically significant for the ≥ 70 age group at 1.73 (95% CI: 1.16 – 2.96). The aHR for DWFG was 2.00 (95% CI: 1.47 – 2.73) for 50 – 59 years; 3.36 (95% CI: 2.47 – 4.58) for 60 – 69; and 5.45 (95% CI: 3.95 – 8.26) for ≥ 70. The aHR for AR was 0.73 (95% CI: 0.61 – 0.88) for 50 – 59 years; 0.69 (95% CI: 0.56 – 0.84) for 60 – 69; and 0.47 (95% CI: 0.31 – 0.72) for ≥ 70.
Conclusion: DDKT recipients over the age of 70 are at a higher risk of UCGF, DCGF, and DWFG but have a lower risk of AR than their younger counterparts.Correspondence to:
Sandesh Parajuli, MD
4175 MFCB, 1685 Highland Ave
Madison, WI 53705, USA
Email: [email protected]

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