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Books: 233	Journals: 18	Articles: 21175

Abstract

Xiaofu Yu, Pan Chu, Chengcheng Yu, and Lei Zhao

Department of Rheumatology and Immunology, Guyuan People’s Hospital, Guyuan, Ningxia Hui Autonomous Region, China
Objective: This study was conceived to compare the clinical efficacy of Tripterygium wilfordii Hook F (TWHF) medical wine and Tripterygium glycoside tablets (TGTs) in patients with primary Sjögren’s syndrome (pSS), mainly focusing on inflammatory markers, autoantibody profiles, and salivary gland function. Materials and methods: In this prospective, randomized controlled trial, 90 pSS patients were enrolled and randomly assigned into a TWHF medical wine group (Observation) or TGTs group (Control), receiving either TWHF medical wine (8 mL, twice daily) or TGTs (10 mg, 3 times daily) for 12 weeks. Primary outcomes included unstimulated whole saliva (UWS) flow rate, EULAR Sjögren’s Syndrome Disease Activity Index (ESSDAI), and positivity rates of anti-SSA/SSB antibodies. Secondary outcomes included subjective symptom scores (EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI)), serum IgG levels, and safety profiles. Results: Baseline characteristics were comparable between the two groups. After 12 weeks, the Observation group showed significantly greater improvements in UWS and ESSDAI scores. The positive rates of anti-SSA and anti-SSB had decreased in both groups, with a more pronounced decline observed in the observation group, though between-group differences were not statistically significant. ESSPRI scores and IgG levels were significantly reduced in both groups, with more pronounced changes in the Observation group. No severe adverse events occurred, and both treatments were well tolerated with comparable safety profiles. Conclusion: TWHF medical wine is more effective than TGTs in improving salivary gland function, systemic disease activity, and immunological profiles in pSS patients, with comparable safety. These results suggest that TWHF medical wine is a suitable alternative treatment for primary Sjögren’s syndrome. Correspondence to:
Lei Zhao, Bachelor, Department of Rheumatology and Immunology, Guyuan People’s Hospital, Guyuan 756000, Ningxia Hui Autonomous Region, China
Email: [email protected]

Abstract

Allergologie select, Vol. 10/2026 (52-62)

The MRGPRX2 paradigm shift: Redefining mast cell activation pathways in chronic urticaria

Kun Wu and Junlin Liu

Department of Dermatology and Venereology, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
Chronic urticaria (CU) is a skin disease characterized by recurrent episodes of vascular dilation and increased permeability of the cutaneous and mucosal microvasculature. Although antihistamines and omalizumab remain first-line and secondline therapies, respectively, a significant proportion of patients develop recalcitrant disease phenotypes, highlighting critical unmet needs for innovative therapeutic paradigms. In recent years, emerging insights into Mas-related G protein-coupled receptor X2 (MRGPRX2) have revealed transformative perspectives for elucidating the pathobiology of refractory CU. As a class A G protein-coupled receptor (GPCR) that is predominantly localized to mast cells, MRGPRX2 orchestrates non-IgE-mediated mast cell degranulation through its pluripotent ligand recognition capacity, engaging diverse exogenous cationic compounds, neuropeptides, and certain pharmacological agents. This comprehensive review evaluates recent advancements in deciphering the mechanistic contributions of MRGPRX2 to CU pathogenesis, with the ultimate aim of informing the development of precision diagnostic and therapeutic frameworks for CU management.Correspondence to:
Prof. Dr. Junlin Liu, Department of Dermatology and Venereology, The Second Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
Email: [email protected]

Abstract

Yadi Wang¹, Keqin Zhang¹, Ling Liu¹, Maozhi Tang¹, Ming Tang¹, Linguo Shen¹, Qiongyao Peng¹, Bangqin Hu², and Zhengsheng Rao¹

¹The Center of Urology and Nephrology, and ²Department of Pharmacy, The Affiliated Hospital of Chongqing Medical University, Chongqing, China
Kidney transplant recipients (KTRs) are at an elevated risks for severe COVID-19 due to immunosuppression and comorbidities. This study retrospectively evaluated the safety and efficacy of nirmatrelvir-ritonavir (NR) in 42 KTRs with COVID-19, adjusting dosages based on estimated glomerular filtration rates. Over a 1-year follow-up, renal and hepatic functions, inflammatory markers, and acute respiratory distress syndrome (ARDS) incidence were monitored. Within the studied cohort, oxygen therapy was required in 64% of patients, with 19% necessitating mechanical ventilation; 21% developed ARDS. Multivariate analysis identified higher albumin levels (odds ratio (OR) = 0.696, 95% confidence interval (CI) 0.515 – 0.940) and CD4⁺ T-cell counts (OR = 0.982, 95% CI 0.968 – 0.998) as protective against ARDS, with an AUC of 0.859. Significant reductions in serum creatinine (p < 0.001) and aspartate aminotransferase (p = 0.01) were observed from admission to discharge, while alanine aminotransferase and estimated glomerular filtration rate (eGFR) remained stable. Complications were rare, occurring in only 2 patients. NR therapy demonstrated safety and effectiveness in KTRs, evidenced by improvements in renal and hepatic function as well as stable graft outcomes. CD4+ T-cell counts and albumin levels were identified as potential predictors of ARDS. These findings underscore the significance of early antiviral intervention and meticulous optimization of immunosuppressive management. However, further validation through larger multicenter prospective studies is necessary. Correspondence to:
Keqin Zhang, MD, The Second Affiliated Hospital of Chongqing Medical University, No. 74 Linjiang Road, Yuzhong District, Chongqing 400010, China
Email: [email protected]

Abstract

Dongming Wu, Jinli Dong, Ping Tan, and Cuiqing Zeng

Nephrology and Rheumatology Department, Guangdong Provincial Hospital of Chinese Medicine Hainan Hospital, Haikou, Hainan, China
Objective: This systematic review and meta-analysis aimed to evaluate the efficacy and safety of tacrolimus in the treatment of lupus nephritis (LN) by synthesizing data from randomized controlled trials (RCTs). Materials and methods: A comprehensive search was conducted in PubMed, EMBASE, Cochrane Library, and Web of Science for RCTs involving tacrolimus in patients with LN, published up to October 31, 2024. Eligible studies compared tacrolimus-either as monotherapy or in combination with agents such as prednisolone or mycophenolate mofetil (MMF) to control treatments like placebo or cyclophosphamide. Two reviewers independently screened the studies, extracted data, and assessed methodological quality. Statistical analyses were performed using Review Manager 5.3 and Stata 15. Standardized mean differences (SMDs) were used for continuous outcomes, and relative risks (RRs) for dichotomous outcomes. Results: Of the 484 records screened, 9 RCTs involving 1,187 patients met the inclusion criteria. Tacrolimus significantly reduced urine protein compared to MMF, placebo, and intravenous cyclophosphamide (SMD: –0.33, 95% CI: –0.48, –0.19, p < 0.0001). It also led to modest improvements in serum creatinine (SMD: 0.17, 95% CI: 0.03, 0.30, p = 0.01) and serum albumin (SMD: 0.19, 95% CI: 0.06, 0.31, p = 0.005). However, no significant differences were observed in SLE Disease Activity Index, proteinuria, or serum C3 levels (p > 0.05). Tacrolimus was associated with a slightly lower risk of adverse events, although the differences was not statistically significant (RR: 0.96, 95% CI: 0.86 – 1.07, p = 0.46). Sensitivity analyses indicated some instability in the results for urine protein and serum creatinine. Conclusion: Tacrolimus appears effective in improving select renal biomarkers in patients with LN, particularly in reducing urine protein and improving serum creatinine and serum albumin levels. However, it showed no significant benefit in other clinical disease activity markers when compared to standard therapies. Although associated with a sightly lower incidence of adverse events, the overall quality of evidence was moderate to low. Further high-quality studies are warranted to confirm these findings. Correspondence to:
Cuiqing Zeng, BA, Nephrology and Rheumatology Department, Guangdong Provincial Hospital of Chinese Medicine Hainan Hospital, Haikou, Hainan, 570203, China
Email: [email protected]

Abstract

Miguel Costa¹,², Natália António¹,²,³, Carolina Félix¹,², Inês Jordão¹,², Patrícia Paiva¹,², Joana Guimarães³, Diogo Fernandes³, Lino Gonçalves³, and Francisco Parente¹

¹Clinical Pharmacology Unit, and ²Institute of Pharmacology and Experimental Therapeutics, Faculty of Medicine, University of Coimbra, and ³Department of Cardiology, ULS Coimbra, E.P.E., Coimbra, Portugal
Objectives: To quantify polypharmacy (≥ 5 drugs) and hyperpolypharmacy (≥ 10 drugs) in pacemaker recipients aged ≥ 65 years and to assess associations with frailty (FRAIL), physical activity (IPAQ), medication adherence (MAT), and healthcare utilization over 6 months. Background: Polypharmacy is common in elderly patients with cardiac devices, but prospective data from European pacemaker clinics on frailty, physical activity, adherence, and prescribing quality are limited. Materials and methods: Prospective, single-center observational study in a Portuguese tertiary pacemaker outpatient clinic (n = 104). Participants (≥ 65 years) were assessed at enrolment and at 3 and 6 months. FRAIL, IPAQ, and MAT were recorded at each timepoint. Healthcare utilization was defined as emergency department visits and/or hospital admissions. STOPP/START v3 was applied descriptively at 6 months. Results: Mean age was 79.1 ± 7.5 years; 69.2% were men. Polypharmacy and hyperpolypharmacy were present in 49.0% and 38.5% at enrolment and 47.5% and 43.4% at 6 months. A higher number of chronic medications was associated with higher FRAIL scores, lower IPAQ scores and more frequent healthcare utilization, whereas MAT scores remained uniformly high. Cardiovascular drugs, diuretics, and proton-pump inhibitors (PPIs) were the most frequently used classes. STOPP/START identified potentially inappropriate medications (notably PPIs and benzodiazepines) and prescribing omissions according to START (notably cardiovascular therapies). Conclusion: Polypharmacy and hyperpolypharmacy are frequent and persistent in elderly pacemaker recipients and are associated with frailty, lower physical activity and higher healthcare utilization. Structured medication review during routine follow-up may help identify PIMs and PPOs and optimize pharmacotherapy. Correspondence to:
Miguel Filipe Oliva Nogueira da Costa, MD, Praceta Professor Mota Pinto, 3004-561 Coimbra, Portugal
Email: [email protected]

Abstract

Kaoru Yagita¹, Hotake Takizawa², Terunori Sano¹, Yuji Nakayma³, Masashi Ogasawara⁴, Ichizo Nishino⁴, Yasushi Ohya², Yuji Takahashi², and Masaki Takao¹

¹Neuropathology Division, Department of Laboratory Medicine, ²Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, ³Department of Pathology, Keio University School of Medicine, and ⁴Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
Noncoding GGC repeat expansion of various genes leads to oculopharyngodistal myopathy (OPDM), an adult-onset progressive neuromuscular disorder characterized by ophthalmoplegia, pharyngeal dysfunction, and distal limb muscular weakness. Recently, clinical overlap among noncoding GGC repeat-associated neuromuscular diseases, including OPDM, fragile X-associated tremor/ataxia syndrome (FXTAS), and neuronal intranuclear inclusion disease (NIID), has been recognized. Here, we present an autopsy case of OPDM with GIPC1 mutation (OPDM2) in a 56-year-old man. Histopathological studies revealed loss of myelinated fibers in the cerebrum and the presence of neuronal and glial intranuclear inclusions, which are commonly observed in FXTAS and NIID. Numerous intranuclear inclusions in oligodendrocytes were a characteristic feature of our autopsied case. Although GGC repeat expansions in distinct genes produce similar neuropathological findings, such as neuronal and glial intranuclear inclusions, the affected cell populations differ.Correspondence to:
Masaki Takao, MD, PhD, Neuropathology Division, Department of Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry, 4 -1-1 Ogawahigashicho, Kodaira, Tokyo
Email: [email protected]

Abstract

Oliver Micke¹, Mathias Seifert², Jens Büntzel³, and Klaus Kisters⁴

¹Department of Radiation Therapy and Radiation Oncology, Franziskus Hospital, Bielefeld, ²Dortmund, ³Department of Otolaryngology, Südharz Hospital, Nordhausen, and ⁴Operasan Dialysis Center, Herne, Germany
Correspondence to:
Prof. Dr. Oliver Micke, Klinik für Strahlentherapie und Radioonkologie, Franziskus Hospital, Kiskerstraße 26, 33615 Bielefeld, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 10/2026 (86-97)

Expert consensus on the long-term use of lanadelumab in hereditary angioedema: Toward harmonized care

Emel Aygören-Pürsün¹, Jens Greve², Inmaculada Martinez-Saguer³, Susanne Trainotti⁴, Mathias Sulk⁵, Bettina Wedi⁶, Ellen Witte-Händel⁷,⁸, and Markus Magerl⁷,⁹

¹University Hospital Frankfurt, Goethe University, Frankfurt, ²Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, ³Haemophilia Centre Rhine Main, Frankfurt/Main, ⁴Technical University of Munich, TUM School of Medicine and Health, Department of Otorhinolaryngology, Head and Neck Surgery, TUM University Hospital, Munich, ⁵Department of Dermatology, University of Münster, Münster, ⁶Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover, ⁷Angioedema Center of Reference and Excellence (ACARE), Institute of Allergology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, ⁸Global Allergy and Asthma Excellence Network, ACARE/UCARE coordinating office, and ⁹Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology and Allergology, Berlin, Germany
Background: Hereditary angioedema (HAE) is a rare, potentially life-threatening disease caused in most cases by C1 inhibitor deficiency. Lanadelumab, a monoclonal antibody targeting plasma kallikrein, is an effective long-term prophylactic (LTP) treatment for HAE. However, consensus on best practices remains lacking. Objectives: This study aimed to report consensus statements on key principles on long-term lanadelumab therapy for HAE in Germany developed at an HAE LTP Expert Meeting in the year 2024 in Frankfurt, Germany. Materials and methods: A multidisciplinary panel of seven German HAE experts participated in a consensus process to align current guidelines with real-world clinical practice. Following literature review and debate, keynotes were drafted, refined, and voted on. Consensus was defined as ≥ 70% agreement. Key domains included: shared decision-making; flexibility in initiating or adjusting prophylaxis; structured patient education; self-administration; individualized dosing; emergency medication availability; and proactive follow-up, including specific guidance for women of childbearing age. Results: Ten core consensus statements were developed, achieving unanimous (100%, n = 9/10 statements) or strong (≥ 85%, n = 1/10 statements) agreement. It is recommended that the decision to initiate long-term prophylaxis be made through shared decision-making and that the decision made can and should be adjusted again in the further course of treatment. It is advisable to train patients in the technique of self-injection and to start therapy with lanadelumab with a 2-week injection interval in accordance with the product information. The injection interval should be adjusted to the individual patient, and all well-controlled patients should be offered the option of extending the interval without compromising the goal of complete disease control. Even and especially when the prophylaxis is well tolerated, emergency medication must not be neglected. Conclusion: These consensus statements provide a practical, expert-endorsed framework for implementing lanadelumab LTP in clinical practice emphasizing individualized treatment aligned with international guidelines and patient needs.Correspondence to:
Markus Magerl, MD, Charité – Universitätsmedizin Berlin, Institute of Allergology, Hindenburgdamm 27, 12203 Berlin, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 10/2026 (63-72)

Prick tests and basophil activation tests in hypersensitivity to SARS-CoV-2 vaccines and components

Anna-Emilia Aust, Heidi Reh, and Bettina Wedi

Department of Dermatology and Allergy, Comprehensive Allergy Center, Hanover Medical School, Hannover, Germany
In collaboration with certified allergy centers (CACs) in Germany, a standardized procedure was developed for the allergologic evaluation of hypersensitivity reactions to SARS-CoV-2 vaccines. Our CAC prospectively evaluated 60 subjects with prior allergic reactions to SARS-CoV-2 vaccines or components. The investigations included a comprehensive medical history, in-vitro and skin tests. Prick tests were negative in all participants. Two positive basophil activation tests suggested a hypersensitivity to the component polyethylene glycol; however, no clinical relevance was found. Approximately 73% of the subjects reported symptoms during subsequent immunizations, which were milder than the reactions prior to the diagnostic procedures. Most index reactions manifested as non-specific symptoms. The results suggest that subsequent vaccinations following diagnostic procedures were well tolerated, underscoring the importance of careful allergological evaluation prior to vaccination.Correspondence to:
Professor Bettina Wedi, MD, Department of Dermatology and Allergy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
Email: [email protected]

Abstract

Allergologie select, Vol. 10/2026 (73-85)

Decoding allergy in vitro: Challenges and clinical use of humoral and cellular methods

Bettina Wedi¹ and Timo Buhl²

¹Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hanover, and ²Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, Göttingen, Germany
In vitro assays are essential tools in diagnosing IgE-mediated allergic diseases and complement clinical history and skin testing across food, inhalant, venom, and drug allergies. This methodological review is intended for clinicians seeking a more detailed understanding of current laboratory-based allergy diagnostics. It summarizes current humoral and cellular diagnostic methods, including total IgE, singleplex and component-resolved specific IgE testing, multiplex IgE platforms, and functional cellular assays such as the basophil activation test and T-cell–based approaches. Humoral assays remain the quantitative foundation of molecular allergy diagnostics, while multiplex arrays broaden diagnostic scope and map sensitization profiles, although platform variability requires cautious interpretation. Cellular assays may add functional information in selected constellations but remain technically demanding, insufficiently standardized, and are best regarded as adjunctive tools in specialized or research settings, with evidence largely derived from selected cohorts. Additional areas – immunotherapy monitoring, mast cell disorders, contact allergy, and oncology – illustrate the broader methodological spectrum of in vitro methods. Persistent unmet needs include harmonization, validated reference standards, and robust interpretive frameworks. Disease-specific applications are discussed in companion articles in this issue.Correspondence to:
Timo Buhl, MD, University Medical Center Göttingen, Department of Dermatology, Venereology and Allergology, Robert Koch Str. 40, 37075 Göttingen, Germany
Email: [email protected]

Abstract

Shi Kay Loong¹, Feifei Wu², Yizhou Liu¹, Napattharin Voratunyakit¹, Shangyu Wei¹, Wei Li¹, Rui Li⁴ and Weidong Pan¹,³,⁴

¹Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of TCM, ²Department of Neurology, Shanghai Pudong New Area Gongli Hospital, ³Department of Neurology, Shanghai Pudong New Area Hospital of Traditional Chinese Medicine, and ⁴Department of Neurology, Anhui Branch of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Hefei, Anhui Province, China
Background: Gastrointestinal symptoms in Parkinson’s disease (PD), in particular chronic constipation, are common and are treated in China using the traditional Chinese medicine (Jia-Wei-Ji-Chuan-Jian decoction) (JWJCJ)). However, information on therapeutic targets and the underlying mechanism is limited. Materials and methods: A total of 72 PD patients with constipation attending Departments of Neurology in Shanghai, China (Shanghai Pudong New Area Gongli Hospital and Shuguang Hospital Affiliated to Shanghai University) were recruited into the study and allocated to a Treatment group (n = 36) and a Control group (n = 36). Patients in the Control group received a combination treatment comprising anti-Parkinson agents (Western drug regimen) with the addition of a traditional Chinese patent medicine (Huang-Xing Run-Chang Tablets*) over a period of 5 weeks, whereas patients in the Treatment group received the same anti-PD Western drug regimen together with the JWJCJ decoction, also for a period of 5 weeks. An evaluation using clinical efficacy scores was carried out together with network pharmacology analysis. Identified drug targets for JWJCJ using the traditional Chinese medicine Swiss Target Prediction database (TCMSP) and disease targets for chronic constipation in PD were obtained from Genecards and the OMIM database. Therapeutic targets for JWJCJ in the treatment of chronic constipation were identified by intersecting drug targets and disease targets. GO functional enrichment analysis, KEGG pathway analysis, and disease association analysis were carried out using the DAVID database and visualized using Cytoscape 3.9.1 software. Results: CSS efficacy scores in the Treatment group were higher than that in the Control group (88.57 vs. 52.94%, p < 0.001). No significant differences were seen prior to treatment in the CSS, PDQ-39 and MDS-UPDRS scores and the corresponding total scores for the two groups. After treatment, CSS values for patients in the Treatment group were higher than values before treatment (p < 0.01). Network pharmacology analysis identified 172 active components, 9,542 drug targets, and 421 intersecting target genes for JWJCJ. PPI analysis identified 10 main and possibly key targets for JWJCJ in the treatment of chronic constipation. KEGG analysis identified 198 signaling pathways, where pathways in cancer, specific cancer pathways such as prostate cancer and non-small cell lung cancer, lipid and atherosclerosis, hepatitis B, and the AGE-RAGE signaling pathway in diabetic complications were among the pathways most significantly enriched. These findings are evidence that the active ingredients in JWJCJ in the treatment of chronic constipation in PD mainly target TP53, SRC, AKT1, PIK3R1, and PIK3CA. Conclusion: The efficacy of JWJCJ in treating chronic constipation in PD involves the targets SRC, PIK3R1, JUN, TP53, STAT3, PIK3CA, EGFR, ESR1, MAPK1, and AKT1 domains. These findings provide theoretical basis for the clinical application of JWJCJ decoction in the treatment of chronic constipation in PD. Correspondence to:
Dr. Rui Li, Department of Neurology, Anhui Branch of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Hefei, Anhui Province, 230031 China, and Professor Weidong Pan, Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
Email: [email protected]

Abstract

International Journal of Clinical Pharmacology and Therapeutics, Vol. 64 – No. 6/2026 (285-288)

Pharmocracy via MCC to de-prescribing: The attempted ascent and descent of Everest

Barrington (Barry) G. Woodcock-Kloberdanz

Abstract

Srecko Marusic¹,²,³, Matea Staresinic⁴, and Maja Cigrovski Berkovic⁵

¹Department of Endocrinology and Clinical Pharmacology, University Hospital Dubrava, ²School of Medicine, ³Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, ⁴Faculty of Medicine, University of Rijeka, Rijeka, and ⁵Department for Sport and Exercise Medicine, Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
Objective: Although uncommon, medications may induce unpleasant body odor, potentially leading to psychosocial distress and reduced treatment adherence. To date, unpleasant body odor has not been recognized as an adverse effect of dulaglutide. We report a novel case of dulaglutide-associated body odor, confirmed by dechallenge and rechallenge. Case report: A 57-year-old man with a 6-year history of type 2 diabetes mellitus and hypertension was initiated on dulaglutide due to inadequate glycemic control and obesity. Two weeks after treatment initiation, an unpleasant body odor was noted by family members and colleagues. No changes in diet, hygiene practices, or concomitant medications were reported. Dermatological examination and extensive laboratory evaluation excluded infectious, metabolic, and endocrine causes. The odor resolved ~ 10 days after discontinuation of dulaglutide. Upon rechallenge, the odor recurred, confirming a causal relationship. Dulaglutide was permanently discontinued, and treatment was switched to semaglutide, after which the body odor did not recur and glycemic control improved. According to the Naranjo Adverse Drug Reaction Probability Scale, the association was classified as probable. Conclusion: This case highlights a rare and previously unreported adverse effect of dulaglutide. Although not medically serious, drug-induced body odor may substantially impair quality of life and treatment adherence. Correspondence to:
Srecko Marusic, Department of Endocrinology and Clinical Pharmacology, University Hospital Dubrava, Av. Gojka Suska 6, 10000 Zagreb, Croatia
Email: [email protected]

Abstract

Raymond Vanholder¹,², Dina Abdellatif³, Augusto Cesar Soares Dos Santos Jr.⁴,⁵, Ricardo Correa-Rotter⁶, Natarajan Gopalakrishnan⁷, Bill Wang⁸, Stefanos Roumeliotis⁹, Alessandro Balducci¹⁰, Ágnes Haris¹¹, Manjusha Yadla¹², and Li-Li Hsiao¹³

¹Nephrology Section, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, ²European Kidney Health Alliance, Brussels, Belgium, ³Department of Nephrology, Cairo University Hospital, Cairo, Egypt, ⁴Faculdade Ciencias Medicas de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil, ⁵Hospital das Clinicas, Ebserh, Universidade Federal de Minas Gerais, Minas Gerais, Brazil, ⁶Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, ⁷Transplant Authority of Tamil Nadu, Chennai, India, ⁸Hong Kong Kidney Foundation, Hong Kong, SAR, China, ⁹²nd Department of Nephrology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, Greece, ¹⁰Italian Kidney Foundation Italy, Rome, Italy, ¹¹Department of Internal Medicine and Nephrology, Péterfy Hospital, Budapest, Hungary, ¹²Department of Nephrology, Gandhi Medical College, Hyderabad, Telangana, India; and ¹³Renal Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
The current kidney care model – focused on late-stage disease and in-center hemodialysis – is unsustainable, because of costs, environmental burden, poor outcomes, and reduced quality of life. The 78th World Health Assembly’s recognition of kidney disease as a serious health threat presents a critical opportunity to reshape kidney care. Aligned with this, the 2026 World Kidney Day theme, “Kidney Health for All: Caring for People, Protecting the Planet”, calls for a systematic change. A sustainable model must prioritize early detection and prevention, reducing the need for kidney replacement therapy. Transplantation and home dialysis benefit people with kidney failure, environment and society. Dialysis itself must become more eco-friendly without compromising care quality, recognizing that planetary perturbations in turn affect kidney health. Conservative care should also be considered, particularly for elderly and frail patients, if the quality-of-life benefits outweigh the perspectives offered by dialysis. Achieving this shift requires coordinated action across all stakeholders; education and engagement of the public, policy makers and health professionals to raise awareness about the threat of kidney disease; and an urgent move toward patient-centered care.Correspondence to:
Dr. Stefanos Roumeliotis, MD, PhD, FERA, Nephrologist, Fellow of the World Kidney Day Joint Steering Committee, 2nd Department of Nephrology, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, 1 St. Kyriakidi street, 54636 Thessaloniki, Greece
Email: [email protected]

Abstract

Jiao Yuan¹,² and Yingsong Jiang¹,²

¹Internal Medicine, Chongqing Medical University, Chinese Academy of Sciences (Chongqing College), and ²Department of Nephrology, Chongqing General Hospital, Chongqing, China
Background: Anemia is common in maintenance hemodialysis (MHD). Therapy with erythropoiesis-stimulating agents (ESAs) may be limited by inflammation-related hyporesponsiveness and safety concerns. Real-world evidence on roxadustat across baseline anemia severities is limited. Materials and methods: In this single-center retrospective cohort, 300 MHD patients who switched from ESAs to roxadustat monotherapy were grouped by baseline hemoglobin (Hb): severe < 80 g/L (n = 82), moderate 80 – 99 g/L (n = 137), and mild 100 – 110 g/L (n = 81). The primary outcome was sustained Hb target achievement (100 – 120 g/L for ≥ 2 consecutive visits within 12 weeks without rescue therapy). Hb trajectories were assessed using linear mixed-effects models, and predictors of target achievement were identified by multivariable logistic regression with false discovery rate adjustment. Results: At 12 weeks, sustained Hb achievement increased with baseline Hb: 46.3% (severe), 64.2% (moderate), and 76.5% (mild) (q = 0.0012). Hb variability decreased across groups (time-weighted coefficients of variation 7.5, 6.1, and 5.2%; q = 0.008). Early Hb rise was fastest in severe anemia (+1.85 vs. +1.24 vs. +0.74 g/L/week over weeks 0 – 4; q = 0.028). Adverse events occurred in 47.7%, mostly grade 1 – 2, without between-group differences in serious events or discontinuation. Higher C-reactive protein (per 10 mg/L, OR 0.42; q = 0.012) and poor prior ESA response (OR 0.60; q = 0.013) predicted lower target attainment, whereas higher prealbumin (per 10 mg/L, OR 1.35; q = 0.004), IV iron (OR 1.52; q = 0.021), and ≥ 50% dose titration (OR 1.59; q = 0.019) predicted higher attainment. Conclusion: Roxadustat improved and stabilized Hb across anemia severities in MHD, with best control in milder anemia; inflammation, nutrition, prior ESA response, iron use, and dose titration influenced success. Correspondence to:
Yingsong Jiang, PhD candidate, Internal Medicine, Chongqing Medical, University, Chinese Academy of Sciences (Chongqing College), No. 1, Medical College Road, Yuzhong District, Chongqing, 400016, China
Email: [email protected]

Abstract

Clinical Neuropathology, Vol. 45 – No. 2/2026 (41)

Clinical Neuropathology 2-2026

Christian Mawrin

Department of Neuropathology, Magdeburg, Germany

Abstract

Society News of the European Confederation of Neuropathological Societies

Abstract

Clinical Nephrology – Case Studies, Vol. 14/2026 (24-29)

Late-onset recurrent lupus nephritis in a kidney transplant recipient

Jessica K. Cobb², Paul Endres², Prashamsa Shenoy¹, Edward J. Filippone¹, Maitreyee Gupta¹, and Rakesh Gulati¹

¹Department of Transplant Nephrology, and ²Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
Long-term kidney allograft survival continues to be a challenge, despite improvements in the short term. Recurrence of glomerular disease is a significant cause of allograft failure. We report a case of graft dysfunction 27 years post transplant attributed to biopsy-proven recurrent class IV lupus nephritis. Following targeted medication adjustments aimed at treating lupus nephritis, the patient achieved complete remission within 6 months, which has been sustained for 4 years. Although recurrent lupus nephritis is reported to occur up to 16 years after transplantation, it is uncommon, and represents a potentially treatable cause of graft failure. This report underscores the critical need for heightened awareness and prompt management of recurrent lupus nephritis regardless of the time post transplant to enhance long-term allograft survival. Furthermore, our case highlights that positive allograft staining in peritubular capillaries for C4d may result from recurrent immunecomplex disease as opposed to antibodymediated rejection.Correspondence to:
Dr. Jessica Cobb, 1199 Ludlow St. #1401, Philadelphia, PA 19107, USA
Email: [email protected]

Abstract

Clinical Nephrology – Case Studies, Vol. 14/2026 (30-38)

A patient with Sagliker syndrome who underwent parathyroidectomy: A case report and literature review

Jianping Ren, Xinyu Li, Baoyu Zhao, Deguang Wang, and Xuerong Wang

Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
Background: Sagliker syndrome (SS) is a rare yet severe complication of end-stage renal disease that is predominantly observed in patients who have undergone prolonged hemodialysis and develop secondary hyperparathyroidism (SHPT). SS is characterized by progressive craniofacial and maxillofacial bone deformities, such as mandibular widening, increased interdental spacing, and neuropsychiatric symptoms including anxiety, depression, and cognitive dysfunction. These manifestations significantly impair the quality of life of affected individuals. Case report: We report the case of a 42-year-old woman undergoing regular hemodialysis who was diagnosed with SHPT and SS. The patient was admitted to the hospital with a 3-year history of skeletal deformity. On December 29, 2012, she underwent total parathyroidectomy (PTx) with some parathyroid tissue transplanted to the left forearm. Over 12 years of regular follow-up, we found that clinical symptoms, such as facial deformity and bone pain, and laboratory indicators, including corrected serum calcium and phosphorus levels, significantly improved. Amazingly, the skull, which was altered in a “salt and pepper” pattern, improved significantly. Conclusion: After PTx in patients with SS, clinical symptoms and related laboratory indicators can be significantly improved, which is conducive to enhancing patient prognosis. Therefore, PTx should be performed in such patients as early as possible. However, further research is needed to develop a more standardized treatment plan for SS.Correspondence to:
Xuerong Wang, MD, Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
Email: [email protected]

Abstract

Julia Schuler¹, Sandra Baur¹, Federico Fusco¹, Felix Schicktanz¹, Benedikt Wiestler², Julian Canisius², Christian Mawrin³, Denise Bernhardt⁴, Arthur Wagner⁵, Bernhard Meyer⁵, Carolin Mogler¹, and Claire Delbridge¹

¹Institute of Pathology, ²Department of Neuroradiology, TUM Klinikum, TUM School of Medicine and Health, Technical University of Munich, Munich, ³Department of Neuropathology, Neurosurgery, and Neurology, Otto-von-Guericke University, Magdeburg, ⁴Department of Radiation Oncology, and ⁵Department of Neurosurgery, TUM Klinikum, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
Intraoperative diagnostics in neuro-oncology face a critical gap between the morphological limitations of hematoxylin-eosin staining or toluidine blue staining and the time-intensive nature of conventional immunohistochemistry (IHC). This delay hinders real-time surgical decision-making, particularly in distinguishing gliomas, metastases, and lymphomas. To address this, we validated a novel, rapid IHC protocol utilizing directly conjugated polymerized horseradish peroxidase (pHRP) antibodies, designed to deliver results in under 30 minutes. We evaluated the performance of pan-cytokeratin (pan-CK), glial fibrillary acidic protein (GFAP), and cluster of differentiation 20 (CD20) antibodies on 115 intraoperative frozen tissue samples. Staining quality was assessed using a 4-tiered scoring system (from 0 to 3+). The cytoplasmic markers GFAP and pan-CK demonstrated excellent robustness and reliability, achieving mean scores of 2.6 and 2.47, respectively, with over 68% of cases showing strong, specific staining (3+). The membrane-bound marker CD20 showed more variability (mean score 2.07), highlighting the influence of antigen localization on this rapid protocol. Our findings demonstrate that this rapid IHC method is a viable and highly effective tool for the intraoperative differentiation of central nervous system tumors, particularly for cytoplasmic antigens. By providing crucial morphological information in near real-time, this approach has the potential to significantly enhance diagnostic precision during surgery, enabling immediate, tailored therapeutic strategies and improving patient outcomes.Correspondence to:
Dr. med. Claire Delbridge, Institute of Pathology, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany, or Julia Schuler, Institute of Pathology, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
Email: [email protected]

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